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General NPI Number Information
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NPI Number | 1700738671
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Entity Type | Individual
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Provider Name | KAIEA LA'IKU VERA ATC
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Gender | Male
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 807 PLEASANT VALLEY RD
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City | WEST BEND
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State | WI
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Zip | 53095-9767
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Country | US
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Telephone | 904-477-4238
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Fax |
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Provider Business Mailing Address
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Address Line | 10900 W BLUEMOUND RD APT 301
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City | WAUWATOSA
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State | WI
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Zip | 53226-4145
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Country | US
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Telephone | 808-937-0494
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3306-39
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License Number State | WI
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