Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT-16 | HI |
N | 225XL0004X | Low Vision | OT-16 | HI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT-16 | HI |
NPI | 1467894683 |
---|---|
Provider Name | Mrs. Konane M Deryke |
First Address | Honolulu, HI 96825-1911 |
Second Address | Honolulu, HI 96825-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 29/07/2013 |