Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MAT-11312 | HI |
NPI | 1013277839 |
---|---|
Provider Name | Mrs. Leilani Marie Jeremiah |
First Address | Makawao, HI 96768-8525 |
Second Address | Kahului, HI 96732-3516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2012 |
Last Update Date | 26/05/2012 |