Provider Demographics
NPI:1285054965
Name:MAKANEOLE, LEIA
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:MAKANEOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 438
Mailing Address - Street 2:
Mailing Address - City:HANAPEPE
Mailing Address - State:HI
Mailing Address - Zip Code:96716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2555A ALA KINOIKI RD.
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756
Practice Address - Country:US
Practice Address - Phone:808-224-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist