Provider Demographics
NPI:1861724437
Name:JIMENEZ, GAY LAUREEN GARRIDO (OT)
Entity type:Individual
Prefix:
First Name:GAY LAUREEN
Middle Name:GARRIDO
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LAUREEN
Other - Middle Name:GARRIDO
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:4315 SIERRA DR.
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-561-4268
Mailing Address - Fax:
Practice Address - Street 1:4315 SIERRA DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3379
Practice Address - Country:US
Practice Address - Phone:808-561-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist