MEDICARE: TERRI S LESAGE-OYAMOT M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	635	HI

General Provider Information

NPI Number	:	1689876385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI S LESAGE-OYAMOT M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	91-6589 KAPOLEI PKWY
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6070
Country	:	US
Telephone Number	:	808-372-7952
Fax Number	:	808-689-3623

Provider Business Practice Location Address
First Line	:	99-080 KAUHALE ST STE D9
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-4114
Country	:	US
Telephone Number	:	808-483-4901
Fax Number	:	808-483-4914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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Directions to “ TERRI S LESAGE-OYAMOT M.S., CCC-SLP” Practice Location

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