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General NPI Number Information
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NPI Number | 1548617178
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Entity Type | Organization
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Legal Business Name | NICOLE'S HEALING HANDS MASSAGE
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 21 D ST SW STE B3
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City | QUINCY
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State | WA
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Zip | 98848-1236
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Country | US
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Telephone | 509-797-5030
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Fax | 509-352-2030
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Provider Business Mailing Address
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Address Line | 21 D ST SW STE B3
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City | QUINCY
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State | WA
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Zip | 98848-1236
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Country | US
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Telephone | 509-797-5030
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Fax | 509-352-2030
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Authorized Official
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Title or Position | OWNER
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Name | MISS NICOLE O'SHEA
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Credential | LMT, CHC
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Telephone | 509-797-5030
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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 | MA00022603
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License Number State | WA
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