Provider Demographics
NPI:1871709816
Name:TOMOSO, ELIZABETH R K (OTR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R K
Last Name:TOMOSO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0130
Mailing Address - Country:US
Mailing Address - Phone:808-565-7204
Mailing Address - Fax:808-565-9319
Practice Address - Street 1:832 KIELE ST
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763
Practice Address - Country:US
Practice Address - Phone:808-565-7204
Practice Address - Fax:808-565-9319
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist