Provider Demographics
NPI:1750019816
Name:BOYLE, ERIN JEAN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JEAN
Last Name:BOYLE
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 1:73 4354 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:180-896-0634
Mailing Address - Fax:
Practice Address - Street 1:73 4354 MAMALAHOA HWY
Practice Address - Street 2:204
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9674
Practice Address - Country:US
Practice Address - Phone:808-960-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15370225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist