Provider Demographics
NPI:1619588415
Name:COMPEHOS, TARA (LM, LMT, CPM)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COMPEHOS
Suffix:
Gender:F
Credentials:LM, LMT, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:PAHALA
Mailing Address - State:HI
Mailing Address - Zip Code:96777-0635
Mailing Address - Country:US
Mailing Address - Phone:808-450-0498
Mailing Address - Fax:
Practice Address - Street 1:94-2166 SOUTH POINT RD.
Practice Address - Street 2:
Practice Address - City:NAALEHU
Practice Address - State:HI
Practice Address - Zip Code:96772
Practice Address - Country:US
Practice Address - Phone:808-450-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMW-23175M00000X
LA333827175M00000X
374J00000X
HI6081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175M00000XOther Service ProvidersMidwife, Lay
No374J00000XNursing Service Related ProvidersDoula