Provider Demographics
NPI:1730201179
Name:MOY, BONNIE Y (OT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:Y
Last Name:MOY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 PROSPECT ST APT 703
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3464
Mailing Address - Country:US
Mailing Address - Phone:443-695-4304
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST STE 730
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1881
Practice Address - Country:US
Practice Address - Phone:808-593-2830
Practice Address - Fax:808-593-2840
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT595225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI59171001Medicaid