MEDICARE: JOHN MICHAEL OSIKA SR. LMBT

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
1	225700000X	Massage Therapist	3890	NC

General Provider Information

NPI Number	:	1083906424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MICHAEL OSIKA SR. LMBT

Provider Business Mailing Address
First Line	:	2006 S MAIN ST
Second Line	:	SUITE 206
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9391
Country	:	US
Telephone Number	:	919-570-6556
Fax Number	:	919-570-6557

Provider Business Practice Location Address
First Line	:	2006 S MAIN ST
Second Line	:	SUITE 206
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9391
Country	:	US
Telephone Number	:	919-570-6556
Fax Number	:	919-570-6557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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