Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 9005 | HI |
NPI | 1003477571 |
---|---|
Provider Name | Ms. Elisha Starr Sevareid |
First Address | Hilo, HI 96721-0085 |
Second Address | Hilo, HI 96720-2133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |