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General NPI Number Information
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NPI Number | 1194438952
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Entity Type | Organization
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Legal Business Name | WHITE OWL HOLISTIC
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Dates
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Enumeration Date | 12/26/2022
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Last Update Date | 12/26/2022
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Provider Practice Location Address
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Address Line | 612 WALNUT ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2321
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Country | US
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Telephone | 315-663-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 612 WALNUT ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-2321
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Country | US
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Telephone | 315-663-5787
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Fax |
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Authorized Official
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Title or Position | CERT. NATURAL HEALTH PRACTITIONER
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Name | SUSAN GIARRUSSO-KRABACHER
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Credential | M.S. ED, C.N.H.P
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Telephone | 315-663-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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