MEDICARE: KARLYN BOCHICCHIO

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	79688	CA

General Provider Information

NPI Number	:	1659182921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLYN BOCHICCHIO

Provider Business Mailing Address
First Line	:	PO BOX 2571
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94953-2571
Country	:	US
Telephone Number	:	678-761-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 KENTUCKY ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2925
Country	:	US
Telephone Number	:	678-761-5805
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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Directions to “ KARLYN BOCHICCHIO ” Practice Location

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