MEDICARE: MRS. HOLLI A DELEON LMT

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	27 023577	NY

General Provider Information

NPI Number	:	1588960603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLI A DELEON LMT

Provider Business Mailing Address
First Line	:	2821 ROUTE 209
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-7661
Country	:	US
Telephone Number	:	845-790-0806
Fax Number	:	845-750-6093

Provider Business Practice Location Address
First Line	:	2821 ROUTE 209
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-7661
Country	:	US
Telephone Number	:	845-790-0806
Fax Number	:	845-750-6093

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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