Healthcare Provider Details

I. General information

NPI: 1710842919
Provider Name (Legal Business Name): KODIE LYNN TOMASZKIEWICZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 18TH ST
EAST MOLINE IL
61244-1436
US

IV. Provider business mailing address

1304 18TH ST
EAST MOLINE IL
61244-1436
US

V. Phone/Fax

Practice location:
  • Phone: 563-639-2197
  • Fax:
Mailing address:
  • Phone: 563-639-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.024240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: