Provider Demographics
NPI:1215722939
Name:WAKELY, GARRY
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:WAKELY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 THURSTON AVE UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3701
Mailing Address - Country:US
Mailing Address - Phone:276-285-8231
Mailing Address - Fax:
Practice Address - Street 1:1598 THURSTON AVE UNIT 1A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3701
Practice Address - Country:US
Practice Address - Phone:276-285-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17900-0225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist