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General NPI Number Information
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NPI Number | 1760031819
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Entity Type | Individual
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Provider Name | KELLI JEAN TOTTEN RBT
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 74-5620 PALANI RD STE 105
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City | KAILUA KONA
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State | HI
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Zip | 96740-3640
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Country | US
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Telephone | 808-640-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 89-754 LANI KONA RD
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City | CAPTAIN COOK
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State | HI
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Zip | 96704-8912
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Country | US
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Telephone | 808-938-9168
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-96428
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License Number State | HI
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