Provider Demographics
NPI:1689061145
Name:MEEHAN-VANDIKE, SAMANTHA J (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:MEEHAN-VANDIKE
Suffix:
Gender:F
Credentials:LMT
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 10327
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-0327
Mailing Address - Country:US
Mailing Address - Phone:808-739-1977
Mailing Address - Fax:808-739-1979
Practice Address - Street 1:1029 KAPAHULU AVE STE 401
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-739-1977
Practice Address - Fax:808-739-1979
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT11727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist