=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710836085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KONA KEIKI CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77-6425 KUAKINI HWY STE B101
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-537-0067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1020
-----------------------------------------------------
City | CAPTAIN COOK
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96704-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-537-0067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | CHANDA ZAVODNY
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 321-537-0067
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------