MEDICARE: CHARISSA ANN STEVENSON MASSAGE THERAPISTS

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	157315	OK

General Provider Information

NPI Number	:	1568078673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA ANN STEVENSON MASSAGE THERAPISTS

Provider Business Mailing Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-673-7633
Fax Number	:	405-673-7638

Provider Business Practice Location Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-824-4150
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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Directions to “ CHARISSA ANN STEVENSON MASSAGE THERAPISTS” Practice Location

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