Provider Demographics
NPI:1588707129
Name:NIIYAMA, GERRAINE ASATO (OTR)
Entity type:Individual
Prefix:
First Name:GERRAINE
Middle Name:ASATO
Last Name:NIIYAMA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1910 KAAHUMANU ST APT E
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3832
Mailing Address - Country:US
Mailing Address - Phone:808-456-7542
Mailing Address - Fax:
Practice Address - Street 1:94-144 FARRINGTON HWY STE 115
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1918
Practice Address - Country:US
Practice Address - Phone:808-678-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT77225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist