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General NPI Number Information
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NPI Number | 1093571762
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Entity Type | Organization
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Legal Business Name | OCEAN SPRINGS THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 6819 WASHINGTON AVE STE F
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2181
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Country | US
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Telephone | 228-697-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 11420 BAYOU PL
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-7907
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Country | US
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Telephone | 228-234-7131
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Fax |
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Authorized Official
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Title or Position | OWNER/ LICENSED MASSAGE THERAPIST
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Name | CHRISTIN M KOTULA
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Credential | LMT #670
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Telephone | 228-697-8860
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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 |
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License Number State |
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