Provider Demographics
NPI:1376733840
Name:GODWIN, KATHERINE K (MS OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MS OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95-390 KUAHELANI AVENUE
Mailing Address - Street 2:#1C
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-445-4428
Mailing Address - Fax:866-637-9592
Practice Address - Street 1:95-390 KUAHELANI AVENUE
Practice Address - Street 2:#1C
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1192
Practice Address - Country:US
Practice Address - Phone:808-445-4428
Practice Address - Fax:866-637-9592
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-668225XP0200X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOT668OtherOT LICENSE