Provider Demographics
NPI:1972877058
Name:DUBY, CAROLE L (LMT)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:L
Last Name:DUBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:YEMAYA
Other - Middle Name:CAROLE
Other - Last Name:DUBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 228
Mailing Address - Street 2:
Mailing Address - City:KILAVEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754
Mailing Address - Country:US
Mailing Address - Phone:808-651-0558
Mailing Address - Fax:
Practice Address - Street 1:365 PAPALOA RD
Practice Address - Street 2:
Practice Address - City:KAPA'A
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-651-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIL.M.T.6260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist