Healthcare Provider Details

I. General information

NPI: 1538407820
Provider Name (Legal Business Name): SALLY BECHTEL L.M.T. N.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4198 PARK AVE W
ONTARIO OH
44903-8589
US

IV. Provider business mailing address

4198 PARK AVE W
ONTARIO OH
44903-8589
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-5947
  • Fax:
Mailing address:
  • Phone: 419-529-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.005448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: