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General NPI Number Information
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NPI Number | 1689061145
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Entity Type | Individual
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Provider Name | SAMANTHA J MEEHAN-VANDIKE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 1029 KAPAHULU AVE STE 401
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City | HONOLULU
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State | HI
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Zip | 96816-1332
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Country | US
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Telephone | 808-739-1977
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Fax | 808-739-1979
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Provider Business Mailing Address
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Address Line | PO BOX 10327
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City | HONOLULU
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State | HI
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Zip | 96816-0327
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Country | US
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Telephone | 808-739-1977
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Fax | 808-739-1979
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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 | MAT11727
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License Number State | HI
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