Provider Demographics
NPI:1619792983
Name:MOTA, ELIZAETH (COTA/L)
Entity type:Individual
Prefix:
First Name:ELIZAETH
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 NUUANU AVE UNIT 27
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3762
Mailing Address - Country:US
Mailing Address - Phone:808-783-6583
Mailing Address - Fax:
Practice Address - Street 1:2705 KAIMUKI AVE RM E-103
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1312
Practice Address - Country:US
Practice Address - Phone:808-784-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOTA-201224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant