Provider Demographics
NPI:1902181571
Name:CATERINA-BOTTORF, CHARMANE (HEARING AID DEALER)
Entity Type:Individual
Prefix:MRS
First Name:CHARMANE
Middle Name:
Last Name:CATERINA-BOTTORF
Suffix:
Gender:F
Credentials:HEARING AID DEALER
Other - Prefix:MS
Other - First Name:CHARMANE
Other - Middle Name:RENEE
Other - Last Name:CATERINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEARING AID DEALER
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1205
Mailing Address - Country:US
Mailing Address - Phone:808-875-4517
Mailing Address - Fax:
Practice Address - Street 1:411 HUKU LII PL
Practice Address - Street 2:SUITE 302
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-875-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist