MEDICARE: KIARREDEN RAVON WRIGHT 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	33.023749	OH

General Provider Information

NPI Number	:	1841945854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARREDEN RAVON WRIGHT LMT

Provider Business Mailing Address
First Line	:	867 BROWNWOOD RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2121
Country	:	US
Telephone Number	:	419-982-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1363
Country	:	US
Telephone Number	:	419-982-1811
Fax Number	:

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

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	01/08/2026

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