Provider Demographics
NPI:1558074138
Name:KAWELO, JORIE K
Entity Type:Individual
Prefix:
First Name:JORIE
Middle Name:K
Last Name:KAWELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2348
Mailing Address - Country:US
Mailing Address - Phone:808-673-6004
Mailing Address - Fax:
Practice Address - Street 1:129 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2348
Practice Address - Country:US
Practice Address - Phone:808-673-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-10740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist