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General NPI Number Information
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NPI Number | 1750510541
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Entity Type | Organization
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Legal Business Name | RAY OF LIGHT HOLISTIC HEALTH, INC.
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 1709 E BRISTOL ST SUITE B
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City | ELKHART
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State | IN
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Zip | 46514-6606
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Country | US
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Telephone | 574-264-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 E BRISTOL ST SUITE B
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City | ELKHART
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State | IN
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Zip | 46514-6606
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Country | US
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Telephone | 574-264-2600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINE LAIDLAW
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Credential | BS, CMT
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Telephone | 574-264-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 84000025A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT20900230
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License Number State | IN
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