Provider Demographics
NPI:1477804342
Name:KAWAGUCHI, TIFFANY-JOY HARUMI (OTD)
Entity Type:Individual
Prefix:
First Name:TIFFANY-JOY
Middle Name:HARUMI
Last Name:KAWAGUCHI
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:TIFFANY-JOY
Other - Middle Name:HARUMI
Other - Last Name:HAMAGUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:94-519 KIILANI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2228
Mailing Address - Country:US
Mailing Address - Phone:808-780-1812
Mailing Address - Fax:
Practice Address - Street 1:45-710 KEAAHALA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3528
Practice Address - Country:US
Practice Address - Phone:808-236-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN