Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT105 | HI |
N | 225XH1200X | Occupational Therapist - Hand | OT105 | HI |
NPI | 1184707663 |
---|---|
Provider Name | Tammy Lee K Momohara |
First Address | Honolulu, HI 96814-1881 |
Second Address | Honolulu, HI 96814-1881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
529406 | (05) | HI |