Provider Demographics
NPI:1407256845
Name:SHAFER, JULIE CHRISTINE (MOT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CHRISTINE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PAPA PL
Mailing Address - Street 2:STE 102
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2988
Mailing Address - Country:US
Mailing Address - Phone:808-873-7700
Mailing Address - Fax:808-873-7710
Practice Address - Street 1:244 PAPA PL
Practice Address - Street 2:STE 102
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2988
Practice Address - Country:US
Practice Address - Phone:808-873-7700
Practice Address - Fax:808-873-7710
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1385225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist