Individual
TALATA NESSIBATOU AWOUSSOU AGOUDAVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
16323 MATHIAS AVE, JAMAICA, NY 11433-3926
(347) 876-1047
Mailing address
16323 MATHIAS AVE, JAMAICA, NY 11433-3926
(347) 876-1047
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032379-01
NY
Other
Enumeration date
04/16/2022
Last updated
04/16/2022
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