=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215165972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIFTS OF MOTHER NATURE MASSAGE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2009
-----------------------------------------------------
Last Update Date | 07/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 S MOON AVE
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-571-1671
-----------------------------------------------------
Fax | 813-571-1693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6401
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33508-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-571-1671
-----------------------------------------------------
Fax | 813-571-1693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MASSAGE THERAPIST
-----------------------------------------------------
Name | MS. KATHIE L LOTTMAN-BROWN
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 813-571-1671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA35121
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------