Provider Demographics
NPI:1063857316
Name:BRAY, AIKO JOY (MT)
Entity Type:Individual
Prefix:
First Name:AIKO JOY
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-0491
Mailing Address - Country:US
Mailing Address - Phone:808-938-9921
Mailing Address - Fax:
Practice Address - Street 1:75-5626 KUAKINI HWY
Practice Address - Street 2:SUITE 17
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3609
Practice Address - Country:US
Practice Address - Phone:808-938-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-11277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist