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General NPI Number Information
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NPI Number | 1457728487
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Entity Type | Organization
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Legal Business Name | EELON WELLNESS AND MASSAGE
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 6414 BEAR CT #207
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City | WALDORF
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State | MD
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Zip | 20603-4301
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Country | US
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Telephone | 352-314-0129
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 BRANCH AVE #207
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City | TEMPLE HILLS
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State | MD
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Zip | 20748-1242
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Country | US
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Telephone | 352-314-0129
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE STEVENS
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Credential | RMP
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Telephone | 240-241-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | R02162
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License Number State | MD
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