Provider Demographics
NPI:1467615278
Name:BEAUCHAMP, SONIA KAY (MT)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:KAY
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-216 FARRINGTON HIGHWAY SUITE 203
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-0171
Mailing Address - Country:US
Mailing Address - Phone:808-285-3009
Mailing Address - Fax:
Practice Address - Street 1:66-216 FARRINGTON HIGHWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791
Practice Address - Country:US
Practice Address - Phone:808-285-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT7465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist