Healthcare Provider Details

I. General information

NPI: 1245163062
Provider Name (Legal Business Name): KYLE OHLIN CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 86TH AVE
OAKLAND CA
94621-1610
US

IV. Provider business mailing address

1260 86TH AVE
OAKLAND CA
94621-1610
US

V. Phone/Fax

Practice location:
  • Phone: 510-346-9265
  • Fax:
Mailing address:
  • Phone: 510-346-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: