Healthcare Provider Details

I. General information

NPI: 1336863521
Provider Name (Legal Business Name): NOEL OHLY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 FAIR ST STE 27
KINGSTON NY
12401-3882
US

IV. Provider business mailing address

275 FAIR ST STE 27
KINGSTON NY
12401-3882
US

V. Phone/Fax

Practice location:
  • Phone: 614-270-7761
  • Fax:
Mailing address:
  • Phone: 614-270-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number030000-02
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: