Healthcare Provider Details

I. General information

NPI: 1164069233
Provider Name (Legal Business Name): SIOBHAN HUTCHINSON MA- HOLISTIC HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2019
Last Update Date: 12/07/2019
Certification Date: 12/07/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 DOVER RD
TOMS RIVER NJ
08757-5404
US

IV. Provider business mailing address

325 HILLTOP LN E
COLUMBUS NJ
08022-1015
US

V. Phone/Fax

Practice location:
  • Phone: 609-752-1048
  • Fax:
Mailing address:
  • Phone: 609-752-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: