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General NPI Number Information
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NPI Number | 1053809236
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Entity Type | Individual
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Provider Name | KATHRYN MISCAVAGE
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Gender | Female
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 4300 S I 10 SERVICE RD W STE 103R
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City | METAIRIE
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State | LA
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Zip | 70001-7440
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Country | US
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Telephone | 504-264-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 TUGIE ST
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City | METAIRIE
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State | LA
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Zip | 70003-3929
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Country | US
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Telephone |
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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 | 3657
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License Number State | LA
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