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General NPI Number Information
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NPI Number | 1760203764
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Entity Type | Individual
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Provider Name | CARMEL CHILTON MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 68-3840 LUA KULA ST ADMIN 3
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City | WAIKOLOA
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State | HI
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Zip | 96738
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Country | US
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Telephone | 808-909-3111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1994
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City | KAMUELA
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State | HI
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Zip | 96743-1994
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Country | US
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Telephone | 808-381-8301
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAT-17814-0
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License Number State | HI
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