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General NPI Number Information
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NPI Number | 1518102722
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Entity Type | Individual
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Provider Name | ETETE L. AGBABUNE MT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 3303 WESTMILL DR SW STE 8
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City | HUNTSVILLE
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State | AL
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Zip | 35805-6133
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Country | US
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Telephone | 256-326-0890
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Fax | 256-326-0890
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Provider Business Mailing Address
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Address Line | PO BOX 11551
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City | HUNTSVILLE
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State | AL
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Zip | 35814-1551
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Country | US
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Telephone | 256-326-0890
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Fax | 256-289-2640
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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 | 1745
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License Number State | AL
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