=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174429914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEASHA MAY IVEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2026
-----------------------------------------------------
Last Update Date | 10/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2604 N ELM ST
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28358-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-258-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 DELICATE DR
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28358-6692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-258-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 23642
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------