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General NPI Number Information
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NPI Number | 1578864955
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Entity Type | Organization
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Legal Business Name | K&K ETM, LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 1321 N BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-4951
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Country | US
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Telephone | 405-216-5252
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Fax | 405-216-5353
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Provider Business Mailing Address
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Address Line | 1321 N BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-4951
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Country | US
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Telephone | 405-216-5252
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Fax | 405-216-5353
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY MCGOWEN
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Credential |
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Telephone | 405-216-5252
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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 |
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License Number State |
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