MEDICARE: ELLEN ANNE KOTT MASSAGE THERAPIST

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	015958-01	NY

General Provider Information

NPI Number	:	1124856034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ANNE KOTT MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	51 FOLSOM AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-1015
Country	:	US
Telephone Number	:	631-793-4520
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 FOLSOM AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-1015
Country	:	US
Telephone Number	:	631-793-4520
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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