Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 453 | HI |
NPI | 1740429893 |
---|---|
Provider Name | Elissa Linda Thompson |
First Address | Kailua, HI 96734-2825 |
Second Address | Kailua, HI 96734-2825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 12/02/2009 |