Provider Demographics
NPI:1487155768
Name:ORA-A, MERLY
Entity type:Individual
Prefix:
First Name:MERLY
Middle Name:
Last Name:ORA-A
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERLITA
Other - Middle Name:
Other - Last Name:ORAA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:603 KAHAKO ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1311
Mailing Address - Country:US
Mailing Address - Phone:808-280-4431
Mailing Address - Fax:
Practice Address - Street 1:845 WAINEE ST STE 100
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2322
Practice Address - Country:US
Practice Address - Phone:808-280-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT14580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty