Provider Demographics
NPI:1417143538
Name:IZUMOTO, MONA (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:IZUMOTO
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LANAKILA AVE # 210
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2115
Mailing Address - Country:US
Mailing Address - Phone:808-832-5688
Mailing Address - Fax:808-832-5696
Practice Address - Street 1:1700 LANAKILA AVE # 210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2115
Practice Address - Country:US
Practice Address - Phone:808-832-5688
Practice Address - Fax:808-832-5696
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT 260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist