Individual
EMMA J LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16-566 KEAAU PAHOA RD # 188-111, KEAAU, HI 96749-8137
(415) 328-6478
Mailing address
73-4282 KEOKEO ST # B, KAILUA KONA, HI 96740-9500
(415) 328-6478
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-80655
CA
Other
Enumeration date
12/24/2019
Last updated
12/24/2019
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