Provider Demographics
NPI:1871744078
Name:LITTLE, KIMBERLY (LMT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 S KING ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1942
Mailing Address - Country:US
Mailing Address - Phone:808-946-5664
Mailing Address - Fax:808-946-5674
Practice Address - Street 1:1521 S KING ST
Practice Address - Street 2:SUITE 405
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1942
Practice Address - Country:US
Practice Address - Phone:808-946-5664
Practice Address - Fax:808-946-5674
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist