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General NPI Number Information
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NPI Number | 1598548489
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Entity Type | Organization
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Legal Business Name | MAGICAL WELLNESS LLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 4-1558 KUHIO HWY
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City | KAPAA
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State | HI
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Zip | 96746-1856
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Country | US
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Telephone | 808-399-8747
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Fax |
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Provider Business Mailing Address
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Address Line | 4-1558 KUHIO HWY
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City | KAPAA
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State | HI
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Zip | 96746-1856
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Country | US
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Telephone | 808-399-8747
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TEMPLE MERRILL-BAUER CLAY
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Credential | LMT
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Telephone | 808-399-8747
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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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