MEDICARE: MS. KANTRELLE LICHELLE STERLING 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		LA

General Provider Information

NPI Number	:	1619566684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KANTRELLE LICHELLE STERLING MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	2652 GOVERNR NICHOLLS ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-3451
Country	:	US
Telephone Number	:	470-265-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2652 GOVERNOR NICHOLLS ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-3451
Country	:	US
Telephone Number	:	470-265-4738
Fax Number	:

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

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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