Provider Demographics
NPI:1750514584
Name:OKAMOTO, CRYSTAL KIYOMI (PT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:KIYOMI
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430B OKA ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5332
Mailing Address - Country:US
Mailing Address - Phone:808-469-6069
Mailing Address - Fax:
Practice Address - Street 1:2430B OKA ST
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5332
Practice Address - Country:US
Practice Address - Phone:808-469-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012038588225100000X
HI2786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist