Provider Demographics
NPI:1609174564
Name:OMURA, PRISCILLA L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:L
Last Name:OMURA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 KANANI RD
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6713
Mailing Address - Country:US
Mailing Address - Phone:808-643-4480
Mailing Address - Fax:
Practice Address - Street 1:44 KANANI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6713
Practice Address - Country:US
Practice Address - Phone:808-643-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist