Provider Demographics
NPI:1699031344
Name:KLEIN, NOA LOGAN (LMT, HHP)
Entity Type:Individual
Prefix:
First Name:NOA
Middle Name:LOGAN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5233
Mailing Address - Country:US
Mailing Address - Phone:808-959-4588
Mailing Address - Fax:808-959-4580
Practice Address - Street 1:2070 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5233
Practice Address - Country:US
Practice Address - Phone:808-959-4588
Practice Address - Fax:808-959-4580
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12728225700000X
CA16497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist