Healthcare Provider Details

I. General information

NPI: 1215295571
Provider Name (Legal Business Name): KARIN CIVELLO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 ROSEDALE DR
NEW ORLEANS LA
70124-1739
US

IV. Provider business mailing address

817 ROSEDALE DR
NEW ORLEANS LA
70124-1739
US

V. Phone/Fax

Practice location:
  • Phone: 504-488-7554
  • Fax: 504-828-3297
Mailing address:
  • Phone: 504-488-7554
  • Fax: 504-828-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA3470
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: