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General NPI Number Information
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NPI Number | 1366956294
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Entity Type | Individual
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Provider Name | MARNITA FOSTER LMT
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Gender | Female
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 211 W MAIN ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-1726
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Country | US
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Telephone | 580-371-6212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77
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City | RAVIA
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State | OK
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Zip | 73455-0077
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Country | US
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Telephone | 580-371-1904
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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 | 173825
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License Number State | OK
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