Provider Demographics
NPI:1346859527
Name:SKAGGS, MAKI (LMT)
Entity Type:Individual
Prefix:
First Name:MAKI
Middle Name:
Last Name:SKAGGS
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 1:4300 WAIALAE AVE APT A1502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5743
Mailing Address - Country:US
Mailing Address - Phone:808-222-1107
Mailing Address - Fax:808-942-1142
Practice Address - Street 1:3660 WAIALAE AVE STE 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3259
Practice Address - Country:US
Practice Address - Phone:808-942-1144
Practice Address - Fax:808-942-1142
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15796225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist