Provider Demographics
NPI:1851759542
Name:MAR, LESLIE ULUMANA JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ULUMANA
Last Name:MAR
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-373 PUNONO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2566
Mailing Address - Country:US
Mailing Address - Phone:808-778-2015
Mailing Address - Fax:
Practice Address - Street 1:94-373 PUNONO ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2566
Practice Address - Country:US
Practice Address - Phone:808-778-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16-1314224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant