Healthcare Provider Details

I. General information

NPI: 1255849923
Provider Name (Legal Business Name): NICOLE M KUCHINSKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 FAYETTE ST
MORGANTOWN WV
26505-0188
US

IV. Provider business mailing address

16659 VETERANS MEMORIAL HWY
KINGWOOD WV
26537-8037
US

V. Phone/Fax

Practice location:
  • Phone: 304-288-0629
  • Fax: 304-288-0629
Mailing address:
  • Phone: 304-288-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2018-3577
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: