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NPI Code Detail

MEDICARE: CAVAN MAIR

MEDICARE: CAVAN MAIR
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 TherapistMA57810FL

General Provider Information

NPI Number : 1508195827
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAVAN MAIR
Provider Business Mailing Address
First Line : 109 THIRD AVE SW
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548
Country : US
Telephone Number : 352-538-7841
Fax Number :
Provider Business Practice Location Address
First Line : 128 EGLIN PKWY NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-4917
Country : US
Telephone Number : 850-864-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2009
Last Update Date : 10/01/2010

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Directions to “ CAVAN MAIR ” Practice Location

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