=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386523546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVE OASIS MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 841 E LINCOLN AVE
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98944-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-831-3266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 S 12TH ST
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98944-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-831-2815
-----------------------------------------------------
Fax | 509-839-8847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MASSAGE THERAPIST
-----------------------------------------------------
Name | AMELIA N ARREOLA
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 509-831-2815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------