Healthcare Provider Details

I. General information

NPI: 1902611999
Provider Name (Legal Business Name): STEPHANIE JILL GOLDMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOTUS BLOSSOM YOGA WELLNESS

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 SE LEE BLVD
LAWTON OK
73501-6558
US

IV. Provider business mailing address

4512 SE LEE BLVD
LAWTON OK
73501-6558
US

V. Phone/Fax

Practice location:
  • Phone: 580-860-6104
  • Fax:
Mailing address:
  • Phone: 580-860-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number90783
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: