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General NPI Number Information
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NPI Number | 1194981654
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Entity Type | Organization
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Legal Business Name | HEALING HANDS OF SUWANNEE COUNTY, LLC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 405 11TH ST SW SUITE A 101-A
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City | LIVE OAK
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State | FL
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Zip | 32064-3161
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Country | US
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Telephone | 386-362-7727
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Fax |
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Provider Business Mailing Address
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Address Line | 405 11TH ST SW SUITE A 101-A
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City | LIVE OAK
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State | FL
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Zip | 32064-3161
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Country | US
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Telephone | 386-362-7727
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MRS. HOLLI JANE LATREILLE
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Credential | MA 52983
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Telephone | 386-362-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MA 52983
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License Number State | FL
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