Provider Demographics
NPI:1720214604
Name:TESHIMA, STACEY FAYO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:FAYO
Last Name:TESHIMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:TESHIMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:161 S. WAKEA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96752
Mailing Address - Country:US
Mailing Address - Phone:808-244-7469
Mailing Address - Fax:808-242-4762
Practice Address - Street 1:161 S. WAKEA AVE.
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96752
Practice Address - Country:US
Practice Address - Phone:808-244-7469
Practice Address - Fax:808-242-4762
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT 895225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics