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General NPI Number Information
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NPI Number | 1043021124
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Entity Type | Individual
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Provider Name | EDELYN PREPOSE SALOOM
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1510 E SEALY AVE
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City | MONAHANS
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State | TX
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Zip | 79756-4050
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Country | US
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Telephone | 503-580-4713
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 HARRISON DR
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City | KERMIT
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State | TX
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Zip | 79745-4904
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Country | US
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Telephone | 503-580-4713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT136559
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License Number State | TX
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