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NPI Code Detail

MEDICARE: KARISSA BEVERAGE M.T.

MEDICARE: KARISSA BEVERAGE M.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMT2355ME

General Provider Information

NPI Number : 1013329747
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARISSA BEVERAGE M.T.
Provider Business Mailing Address
First Line : PO BOX 651
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-0651
Country : US
Telephone Number : 207-594-2122
Fax Number :
Provider Business Practice Location Address
First Line : 7 LIMEROCK ST
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-2928
Country : US
Telephone Number : 207-594-2122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2014
Last Update Date : 05/29/2014

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Directions to “ KARISSA BEVERAGE M.T.” Practice Location

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