MEDICARE: ORA MAE CELESTINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT107121	TX

General Provider Information

NPI Number	:	1053647644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORA MAE CELESTINE

Provider Business Mailing Address
First Line	:	3130 CRESTDALE DR APT 1071
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3935
Country	:	US
Telephone Number	:	832-790-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 CRESTDALE DR APT 1071
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3935
Country	:	US
Telephone Number	:	832-790-9907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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Directions to “ ORA MAE CELESTINE ” Practice Location

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