MEDICARE: ONI TWANISHA ROBERTS N.C.T.M.B, L.N.M.T.

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	MT000896	GA

General Provider Information

NPI Number	:	1790084937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONI TWANISHA ROBERTS N.C.T.M.B, L.N.M.T.

Provider Business Mailing Address
First Line	:	160 CLAIREMONT AVE STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2546
Country	:	US
Telephone Number	:	404-348-0454
Fax Number	:	404-518-6496

Provider Business Practice Location Address
First Line	:	160 CLAIREMONT AVE STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2546
Country	:	US
Telephone Number	:	404-348-0454
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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