Healthcare Provider Details

I. General information

NPI: 1427487701
Provider Name (Legal Business Name): MRS. ORAWAN SAENGSURIYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 S EVERGREEN AVE
ARLINGTON HEIGHTS IL
60005-1427
US

IV. Provider business mailing address

208 S GREENWOOD AVE
PALATINE IL
60074-6333
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-5209
  • Fax:
Mailing address:
  • Phone: 847-963-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227008332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: