Basic Information
| Provider Information | |||||||||
| NPI: | 1588707129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIIYAMA | ||||||||
| FirstName: | GERRAINE | ||||||||
| MiddleName: | ASATO | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98-1910 KAAHUMANU ST APT E | ||||||||
| Address2: | |||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967823832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084567542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 94-144 FARRINGTON HWY STE 115 | ||||||||
| Address2: | |||||||||
| City: | WAIPAHU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967971918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086783637 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225X00000X | OT77 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.