Provider Demographics
NPI:1841474376
Name:CAMACHO-FUENTES, SHERIELEE P (OTR)
Entity type:Individual
Prefix:
First Name:SHERIELEE
Middle Name:P
Last Name:CAMACHO-FUENTES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHERIELEE
Other - Middle Name:P
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1360 S BERETANIA ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1520
Mailing Address - Country:US
Mailing Address - Phone:808-521-4766
Mailing Address - Fax:808-521-4768
Practice Address - Street 1:1360 S BERETANIA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1520
Practice Address - Country:US
Practice Address - Phone:808-521-4766
Practice Address - Fax:808-521-4768
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT25225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI507923Medicaid
HIH54274Medicare PIN