MEDICARE: KAITLIN VICTORIA NOVOA LMT

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	3804	AR

General Provider Information

NPI Number	:	1568221265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN VICTORIA NOVOA LMT

Provider Business Mailing Address
First Line	:	105 BRITTANY
Second Line	:
City	:	POCOLA
State	:	OK
Zip	:	74902-2362
Country	:	US
Telephone Number	:	918-839-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 S WALDRON RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2583
Country	:	US
Telephone Number	:	479-452-4433
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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