Provider Demographics
NPI:1548841968
Name:ZIMMERMAN, KATELYN LEA
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEA
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 N KALAHEO AVE # A
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2319
Mailing Address - Country:US
Mailing Address - Phone:808-386-4097
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST STE 900
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1875
Practice Address - Country:US
Practice Address - Phone:808-593-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist