Provider Demographics
NPI:1801015219
Name:MCDANIEL, MARTHA JEAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEAN
Last Name:MCDANIEL
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 1098
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1098
Mailing Address - Country:US
Mailing Address - Phone:808-281-0302
Mailing Address - Fax:
Practice Address - Street 1:70 CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1701
Practice Address - Country:US
Practice Address - Phone:808-281-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT5416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist