Provider Demographics
NPI:1457128464
Name:TANIGUCHI, MICAH (OTD)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:TANIGUCHI
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 ALA AOLANI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1414
Mailing Address - Country:US
Mailing Address - Phone:808-284-6526
Mailing Address - Fax:
Practice Address - Street 1:1740 ALA AOLANI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1414
Practice Address - Country:US
Practice Address - Phone:808-284-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-2432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist