Provider Demographics
NPI:1821122862
Name:ROSSLER, DOREEN B (MAT)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:B
Last Name:ROSSLER
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ATKINSON DR
Mailing Address - Street 2:#1501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4719
Mailing Address - Country:US
Mailing Address - Phone:808-947-0807
Mailing Address - Fax:808-596-7305
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1210
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-7300
Practice Address - Fax:808-596-7305
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-2240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist