Provider Demographics
NPI:1598548489
Name:MAGICAL WELLNESS LLC
Entity Type:Organization
Organization Name:MAGICAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TEMPLE
Authorized Official - Middle Name:MERRILL-BAUER
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-399-8747
Mailing Address - Street 1:4-1558 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1856
Mailing Address - Country:US
Mailing Address - Phone:808-399-8747
Mailing Address - Fax:
Practice Address - Street 1:4-1558 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1856
Practice Address - Country:US
Practice Address - Phone:808-399-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty