Basic Information
| Provider Information | |||||||||
| NPI: | 1629201439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATANABE | ||||||||
| FirstName: | JONI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 SOUTH WAKEA AVENUE | ||||||||
| Address2: | IMUA FAMILY SERVICES | ||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082424762 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 SOUTH WAKEA AVENUE | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082447467 | ||||||||
| FaxNumber: | 8082424762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2009 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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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 | 225X00000X | 958 | HI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | 958 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.