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General NPI Number Information
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NPI Number | 1386232858
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Entity Type | Individual
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Provider Name | KEVIN LEON WATKINS II MAT
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Gender | Male
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Dates
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Enumeration Date | 01/09/2021
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Last Update Date | 01/09/2021
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Provider Practice Location Address
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Address Line | 2611 LIOHOLO PL
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City | KIHEI
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State | HI
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Zip | 96753-7118
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Country | US
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Telephone | 808-250-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 LIOHOLO PL
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City | KIHEI
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State | HI
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Zip | 96753-7118
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Country | US
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Telephone | 808-250-0104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAT-14629
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License Number State | HI
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