Provider Demographics
NPI:1780801647
Name:KANELOS, LYNETTE DAY (OT)
Entity type:Individual
Prefix:MISS
First Name:LYNETTE
Middle Name:DAY
Last Name:KANELOS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:DAY
Other - Last Name:KANELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:156 ALALUANA RD
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7208
Mailing Address - Country:US
Mailing Address - Phone:815-263-5436
Mailing Address - Fax:
Practice Address - Street 1:156 ALALUANA RD
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7208
Practice Address - Country:US
Practice Address - Phone:808-572-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1246171W00000X, 225X00000X
WAOT00004470171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor