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General NPI Number Information
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NPI Number | 1639711906
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Entity Type | Individual
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Provider Name | KITIMA LEGRAND LMT
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 315 MAIN ST
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City | METUCHEN
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State | NJ
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Zip | 08840-2459
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Country | US
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Telephone | 732-305-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 FOREST HAVEN BLVD
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City | EDISON
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State | NJ
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Zip | 08817-6323
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Country | US
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Telephone | 908-590-0197
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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 | 18KT01339800
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License Number State | NJ
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