Provider Demographics
NPI:1609330018
Name:MARKLEY, MICKAYLA MARIE (MAT)
Entity Type:Individual
Prefix:MRS
First Name:MICKAYLA
Middle Name:MARIE
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:MICKAYLA
Other - Middle Name:MARIE
Other - Last Name:MONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT
Mailing Address - Street 1:73-4615 KOHANAIKI ROAD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:907-841-6725
Mailing Address - Fax:
Practice Address - Street 1:74-5620 PALANI RD STE 102
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3640
Practice Address - Country:US
Practice Address - Phone:907-841-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI14508OtherMAT