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General NPI Number Information
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NPI Number | 1972914885
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Entity Type | Organization
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Legal Business Name | KNEADING PALMS MASSAGE
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 4806 N PERKINS RD
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City | STILLWATER
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State | OK
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Zip | 74075-1710
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Country | US
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Telephone | 405-334-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 4806 N PERKINS RD
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City | STILLWATER
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State | OK
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Zip | 74075-1710
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Country | US
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Telephone | 405-334-7812
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED MASSAGE THERAPIST
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Name | BRANDY MINOR
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Credential | LMT
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Telephone | 405-334-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 0001474
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License Number State | OK
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