Provider Demographics
NPI:1760224034
Name:LOWE, NAOMI MELODY
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:MELODY
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:MELODY
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT
Mailing Address - Street 1:4510 SALT LAKE BLVD STE B6
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3171
Mailing Address - Country:US
Mailing Address - Phone:808-321-7135
Mailing Address - Fax:808-200-3607
Practice Address - Street 1:4510 SALT LAKE BLVD STE B6
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3171
Practice Address - Country:US
Practice Address - Phone:808-321-7135
Practice Address - Fax:808-200-3607
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty