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General NPI Number Information
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NPI Number | 1174804173
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Entity Type | Organization
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Legal Business Name | THE CUTTAGE SALON DBA BLISS SALON
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 6929 ERIE RD
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City | DERBY
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State | NY
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Zip | 14047-9406
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Country | US
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Telephone | 716-947-9028
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Fax |
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Provider Business Mailing Address
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Address Line | 6929 ERIE RD
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City | DERBY
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State | NY
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Zip | 14047-9406
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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 | OWNER
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Name | MRS. BRENDA M MALCZEWSKI
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Credential |
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Telephone | 716-870-8137
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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 | 024387
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License Number State | NY
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