Provider Demographics
NPI:1528635026
Name:OUTDOOR OHANA OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:OUTDOOR OHANA OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & OCCUPATIONAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:510-688-0671
Mailing Address - Street 1:619 PAOPUA LOOP
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3535
Mailing Address - Country:US
Mailing Address - Phone:510-688-0671
Mailing Address - Fax:
Practice Address - Street 1:619 PAOPUA LOOP
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3535
Practice Address - Country:US
Practice Address - Phone:510-688-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIOT-1997OtherSTATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS