MEDICARE: ROSE MIREILLE OJO

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	MA80358	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24975138	OTHER		N/A

General Provider Information

NPI Number	:	1134851660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE MIREILLE OJO

Provider Business Mailing Address
First Line	:	1022 INDIAN TRACE CIR APT 104
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1156
Country	:	US
Telephone Number	:	386-262-5804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 INDIAN TRACE CIR APT 104
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1156
Country	:	US
Telephone Number	:	386-262-5804
Fax Number	:

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

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	07/06/2022

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Directions to “ ROSE MIREILLE OJO ” Practice Location

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