Individual
MICA S JOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10805 FLORIAN AVE # UP, CLEVELAND, OH 44111-3706
(216) 832-8935
Mailing address
10805 FLORIAN AVE # UP, CLEVELAND, OH 44111-3706
(216) 832-8935
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33.021501-H-K
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1325669
AMERICAN MASSAGE THERAPY ASSOCIATION
OH
01
—
33.021501-H-K
STATE OF OHIO MEDICAL BOARD
OH
Enumeration date
01/09/2018
Last updated
01/09/2018
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