MEDICARE: MARIA OVCHINNIKOVA 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	0019010957	VA

General Provider Information

NPI Number	:	1740974351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA OVCHINNIKOVA LMT

Provider Business Mailing Address
First Line	:	739 APPALACHIAN CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-1623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 S ROSEMONT RD STE 111
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4353
Country	:	US
Telephone Number	:	757-718-8536
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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