Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT 107 | HI |
NPI | 1912243387 |
---|---|
Provider Name | Doris Young |
First Address | Honolulu, HI 96813-2402 |
Second Address | Honolulu, HI 96813-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 12/12/2012 |