=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982334835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA BITHELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2022
-----------------------------------------------------
Last Update Date | 06/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 SW SHOREWOOD DR
-----------------------------------------------------
City | DUNNELLON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34431-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-599-0643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 SW SHOREWOOD DR
-----------------------------------------------------
City | DUNNELLON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34431-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-599-0643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 94074
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------