Individual
MR. KEVIN LEON WATKINS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT
Contact information
Practice address
2611 LIOHOLO PL, KIHEI, HI 96753-7118
(808) 250-0104
Mailing address
2611 LIOHOLO PL, KIHEI, HI 96753-7118
(808) 250-0104
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-14629
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11111111111
NOT APPLICABLE
HI
Enumeration date
01/09/2021
Last updated
01/09/2021
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