Provider Demographics
NPI:1235385436
Name:HO, JENNIFER SUSANNE (LMT,CIIM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUSANNE
Last Name:HO
Suffix:
Gender:F
Credentials:LMT,CIIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HOKU ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3845
Mailing Address - Country:US
Mailing Address - Phone:808-934-2273
Mailing Address - Fax:
Practice Address - Street 1:1059 KILAUEA AVE
Practice Address - Street 2:STE C
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4201
Practice Address - Country:US
Practice Address - Phone:808-934-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT1765173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist