Individual
KOEHLER LESLIE RADDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
4214 CLINTON ST, WEST SENECA, NY 14224-1606
(716) 675-2225
Mailing address
4214 CLINTON ST, WEST SENECA, NY 14224-1606
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030336
NY
Other
Enumeration date
12/26/2018
Last updated
12/26/2018
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