Provider Demographics
NPI:1780160648
Name:EGELER, VIOLET
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:EGELER
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-0897
Mailing Address - Country:US
Mailing Address - Phone:808-756-1043
Mailing Address - Fax:
Practice Address - Street 1:21 KALANIANAOLE AVE STE C
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4770
Practice Address - Country:US
Practice Address - Phone:808-969-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist