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General NPI Number Information
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NPI Number | 1790918266
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Entity Type | Organization
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Legal Business Name | BODYPRO OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 64-974 MAMALAHOA HWY
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City | KAMUELA
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State | HI
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Zip | 96743-7334
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Country | US
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Telephone | 808-887-1371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63
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City | KAMUELA
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State | HI
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Zip | 96743-0063
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Country | US
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Telephone | 808-887-1371
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MRS. JUNE KANIHO
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Credential | OTR
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Telephone | 808-887-1371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 252
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License Number State | HI
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