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General NPI Number Information
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NPI Number | 1639477672
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Entity Type | Individual
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Provider Name | GRACE OKON PAUL-XAVIER LMT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 2655 E OAKLAND PARK BLVD STE 6
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1608
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Country | US
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Telephone | 954-564-9536
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Fax | 954-514-9298
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Provider Business Mailing Address
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Address Line | 191 NE 210TH ST
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City | MIAMI
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State | FL
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Zip | 33179-1008
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Country | US
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Telephone | 954-294-9403
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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 | MA-21007
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License Number State | FL
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