Healthcare Provider Details

I. General information

NPI: 1619899101
Provider Name (Legal Business Name): CIERRA SEALS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 S MOUNT ZION RD STE A
DECATUR IL
62521-9721
US

IV. Provider business mailing address

2888 S MOUNT ZION RD STE A
DECATUR IL
62521-9721
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-1127
  • Fax: 217-864-1127
Mailing address:
  • Phone: 217-864-1127
  • Fax: 217-864-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227022835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: