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General NPI Number Information
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NPI Number | 1316618176
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Entity Type | Individual
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Provider Name | MARISA KAITLYN WOOD CMT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1025 B ST
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City | HAYWARD
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State | CA
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Zip | 94541-4107
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Country | US
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Telephone | 510-733-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 E 23RD ST APT 4
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City | OAKLAND
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State | CA
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Zip | 94606-2742
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Country | US
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Telephone | 925-951-7313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 81728
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License Number State | CA
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