Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 410 | HI |
NPI | 1730513920 |
---|---|
Provider Name | Ms. Roberta Ann Medeiros |
First Address | Ewa Beach, HI 96706-4947 |
Second Address | Pearl City, HI 96782-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2013 |
Last Update Date | 24/08/2013 |