MEDICARE: KARIANNE CISEK

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
2	225700000X	Massage Therapist	33.023747	OH
3	225700000X	Massage Therapist	33.023741	OH

General Provider Information

NPI Number	:	1407459845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIANNE CISEK

Provider Business Mailing Address
First Line	:	321 E ROYAL FOREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2129
Country	:	US
Telephone Number	:	330-559-5833
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 E ROYAL FOREST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2129
Country	:	US
Telephone Number	:	330-559-5833
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ KARIANNE CISEK ” Practice Location

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