Healthcare Provider Details

I. General information

NPI: 1548941685
Provider Name (Legal Business Name): LUCINDA SHOAFF BUNSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 CLEVELAND RD E
HURON OH
44839-9704
US

IV. Provider business mailing address

5007 CLEVELAND RD E
HURON OH
44839-9704
US

V. Phone/Fax

Practice location:
  • Phone: 144-091-5829
  • Fax:
Mailing address:
  • Phone: 144-091-5829
  • 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:
Title or Position:
Credential:
Phone: