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General NPI Number Information
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NPI Number | 1467793653
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Entity Type | Individual
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Provider Name | MRS. TABITHA A SCHULTE
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Gender | Female
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 4425 INDUSTRIAL DR
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City | ALTON
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State | IL
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Zip | 62002-5939
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Country | US
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Telephone | 618-917-4475
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Fax |
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Provider Business Mailing Address
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Address Line | 26693 SPRUCE CT
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City | GODFREY
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State | IL
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Zip | 62035-3671
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Country | US
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Telephone | 618-917-4475
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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 | 227.011617
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License Number State | IL
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