=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609486950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVE CHILD DEVELOPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2020
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 KAILUA RD STE 102B
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-400-0073
-----------------------------------------------------
Fax | 808-707-8237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 KAILUA RD STE 102B
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | AUBREANNA ELIZABETH COVERT
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 480-489-3954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------