Organization
EDEN MASSAGE & SPA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACE OKON PAUL LMT (OWNER/PRESIDENT)
(954) 564-9536
Entity
Organization
Contact information
Practice address
2655 E OAKLAND PARK BLVD, SUITE #2, FORT LAUDERDALE, FL 33306-1608
(954) 564-9536
(954) 565-2910
Mailing address
2655 E OAKLAND PARK BLVD, SUITE #2, FORT LAUDERDALE, FL 33306-1608
(954) 564-9536
(954) 565-2910
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LIC #19555
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
686157196
MED WAIVER
FL
Enumeration date
05/19/2008
Last updated
05/19/2008
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