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General NPI Number Information
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NPI Number | 1093138133
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Entity Type | Organization
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Legal Business Name | OGHAM YOGAM INC.
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Dates
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Enumeration Date | 01/25/2014
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Last Update Date | 01/25/2014
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Provider Practice Location Address
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Address Line | 1417 S OAK AVE
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City | SANFORD
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State | FL
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Zip | 32771-3449
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Country | US
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Telephone | 407-431-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 S OAK AVE
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City | SANFORD
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State | FL
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Zip | 32771-3449
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Country | US
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Telephone | 407-431-2325
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSHUA JACOB BUCHANAN
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Credential | L.M.T.
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Telephone | 407-431-2325
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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 | MA 74635
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License Number State | FL
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