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General NPI Number Information
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NPI Number | 1649534884
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Entity Type | Individual
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Provider Name | SHAUNNA DEZRAE KAMANU'ENA HERMOSURA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 860 4TH ST STE 150
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City | PEARL CITY
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State | HI
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Zip | 96782-3690
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Country | US
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Telephone | 808-453-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 94-164 KUPUOHI PL
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City | WAIPAHU
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State | HI
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Zip | 96797-1122
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Country | US
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Telephone | 808-306-5029
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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 | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT1120
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License Number State | HI
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