Provider Demographics
NPI:1033693148
Name:CAUSEY, HEATHER SHENNAN (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SHENNAN
Last Name:CAUSEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NOHOKAI ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8243
Mailing Address - Country:US
Mailing Address - Phone:131-651-8717
Mailing Address - Fax:
Practice Address - Street 1:380 HUKU LII PL STE 105
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7043
Practice Address - Country:US
Practice Address - Phone:808-879-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI15516OtherLICENSE MASSAGE THERAPIST