Basic Information
| Provider Information | |||||||||
| NPI: | 1235520008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHELONA | ||||||||
| FirstName: | MARSHA | ||||||||
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| Credential: | LMT, COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 KUNEHI ST | ||||||||
| Address2: | 110 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086749595 | ||||||||
| FaxNumber: | 8086749696 | ||||||||
| Practice Location | |||||||||
| Address1: | 91-1027 SHANGRILA ST | ||||||||
| Address2: | 1867 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086749595 | ||||||||
| FaxNumber: | 8086749696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 13247 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.