MEDICARE: KLEIDY L BOTICH 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	MA106195	FL
2	225700000X	Massage Therapist	84888	CA

General Provider Information

NPI Number	:	1750061115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KLEIDY L BOTICH MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	91 1398 HALILI ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706
Country	:	US
Telephone Number	:	515-057-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 MOUNTAIN DR
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-7327
Country	:	US
Telephone Number	:	951-505-7600
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	01/27/2026

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Directions to “ KLEIDY L BOTICH MASSAGE THERAPIST” Practice Location

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