Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 8588 | HI |
NPI | 1003053562 |
---|---|
Provider Name | Tai Hawkins |
First Address | Kailua, HI 96734-2022 |
Second Address | Kailua, HI 96734-2022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |