Provider Demographics
NPI:1093889834
Name:DOESCHER, REBECCA LEILANI (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEILANI
Last Name:DOESCHER
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 1:1471 PUEO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5301
Mailing Address - Country:US
Mailing Address - Phone:808-282-6981
Mailing Address - Fax:808-732-4244
Practice Address - Street 1:4747 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5308
Practice Address - Country:US
Practice Address - Phone:808-732-2244
Practice Address - Fax:808-732-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1052259OtherAMERICAN SPECIALTY HEALTH