Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | ||
N | 224Z00000X | Occupational Therapy Assistant | HI |
NPI | 1023664489 |
---|---|
Provider Name | Carrie A Masuda |
First Address | Honolulu, HI 96816-4400 |
Second Address | Honolulu, HI 96816-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |