Provider Demographics
NPI:1093919383
Name:SPATES, CAB (MT)
Entity Type:Individual
Prefix:MR
First Name:CAB
Middle Name:
Last Name:SPATES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-403 PAALAA RD
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712
Mailing Address - Country:US
Mailing Address - Phone:808-389-2227
Mailing Address - Fax:
Practice Address - Street 1:66-403 PAALAA RD
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1439
Practice Address - Country:US
Practice Address - Phone:808-389-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist