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General NPI Number Information
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NPI Number | 1851106686
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Entity Type | Organization
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Legal Business Name | SACRED OAK LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 277 STATE ST STE 1A
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City | BANGOR
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State | ME
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Zip | 04401-5440
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Country | US
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Telephone | 207-991-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 696 HUDSON RD
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City | GLENBURN
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State | ME
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Zip | 04401-1492
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Country | US
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Telephone | 207-991-3996
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACY JH CRAWFORD
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Credential | LMT, CNH
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Telephone | 207-991-3996
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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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