Individual
GAWA KEALOHA TAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15-1925 14TH AVE, KEAAU, HI 96749-9674
(808) 966-4747
Mailing address
HC 3 BOX 11015, KEAAU, HI 96749-9205
(808) 966-4747
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11333
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11333
PRIVATE INSURANCE
HI
Enumeration date
03/12/2019
Last updated
03/12/2019
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