Provider Demographics
NPI:1831292820
Name:SMITH, JOLENE LONA (PT , COMT)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:LONA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT , COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 ALA MOANA BLVD
Mailing Address - Street 2:APT. 1505
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1460
Mailing Address - Country:US
Mailing Address - Phone:808-393-5665
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1113
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-218-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI573271Medicaid
HI251652OtherHMSA # HANDSON
HI251652OtherHMSA # HANDSON