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General NPI Number Information
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NPI Number | 1124815873
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Entity Type | Organization
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Legal Business Name | BALSAM BOSOM WELLNESS AND RESTORATIVE CENTER LLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 10930 US HIGHWAY 231
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City | WETUMPKA
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State | AL
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Zip | 36092-5115
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Country | US
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Telephone | 334-478-3168
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Fax |
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Provider Business Mailing Address
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Address Line | 10930 US HIGHWAY 231
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City | WETUMPKA
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State | AL
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Zip | 36092-5115
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Country | US
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Telephone | 334-478-3168
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JULIA M. KLINE-FUENTES
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Credential |
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Telephone | 334-478-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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