Provider Demographics
NPI:1073150348
Name:MAGNUSSON, JOY (BSC(OT))
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:BSC(OT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 GARDENER WAY
Mailing Address - Street 2:
Mailing Address - City:COMOX
Mailing Address - State:BC
Mailing Address - Zip Code:V9M0B2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75-165 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3722
Practice Address - Country:US
Practice Address - Phone:808-329-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist