Provider Demographics
NPI:1396989224
Name:KEALOHA, WILLIAM JR (MPH, OTR/L)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:KEALOHA
Suffix:JR
Gender:M
Credentials:MPH, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 PROSPECT ST APT 201
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1902
Mailing Address - Country:US
Mailing Address - Phone:808-216-2050
Mailing Address - Fax:
Practice Address - Street 1:666 PROSPECT ST APT 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-1902
Practice Address - Country:US
Practice Address - Phone:808-216-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
587007OtherNBCOT