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General NPI Number Information
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NPI Number | 1699180273
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Entity Type | Organization
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Legal Business Name | OMNIQUEST LIVING COMPANY
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 2510 N MOUNT JULIET RD
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City | MOUNT JULIET
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State | TN
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Zip | 37122-3007
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Country | US
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Telephone | 615-414-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 311 LAKEVIEW CIR
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City | MOUNT JULIET
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State | TN
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Zip | 37122-2099
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Country | US
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Telephone | 615-414-8899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VALERIE DENNISON
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Credential | LMT
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Telephone | 615-414-8899
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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 | ME3450
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License Number State | TN
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