Healthcare Provider Details

I. General information

NPI: 1215167846
Provider Name (Legal Business Name): ELLICOTTVILLE OASIS DAY SPA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 JEFFERSON ST.
ELLICOTTVILLE NY
14731-0781
US

IV. Provider business mailing address

PO BOX 781 23 JEFFERSON ST.
ELLICOTTVILLE NY
14731-0781
US

V. Phone/Fax

Practice location:
  • Phone: 716-699-8996
  • Fax:
Mailing address:
  • Phone: 716-699-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE BENNETT TIMKEY
Title or Position: OWNER
Credential:
Phone: 716-699-8996