Provider Demographics
NPI:1700639481
Name:PERALTA-OTSUKA, BRITTANY N (MAT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:PERALTA-OTSUKA
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S KING ST STE 1654
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1950
Mailing Address - Country:US
Mailing Address - Phone:808-924-7246
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST STE 1654
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1950
Practice Address - Country:US
Practice Address - Phone:808-924-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist