Provider Demographics
NPI:1417510041
Name:JONICK, SEAN (OT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:JONICK
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HUKU LII PL STE 101
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-879-0077
Mailing Address - Fax:
Practice Address - Street 1:1827 WELLS ST STE 2
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2370
Practice Address - Country:US
Practice Address - Phone:808-244-0077
Practice Address - Fax:808-244-0177
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI378225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist