Healthcare Provider Details

I. General information

NPI: 1396258158
Provider Name (Legal Business Name): ORIENTAL HEALING OASIS & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MCHENRY ST
BURLINGTON WI
53105-1825
US

IV. Provider business mailing address

149 MCHENRY ST
BURLINGTON WI
53105-1825
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-9355
  • Fax: 262-342-5151
Mailing address:
  • Phone: 262-763-9355
  • Fax: 262-342-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number619-055
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13965-146
License Number StateWI

VIII. Authorized Official

Name: CHARLOTTE ANGELINI
Title or Position: OWNER/CLINIC DIRECTOR
Credential: MSOM, L.AC.
Phone: 262-763-9355