Individual
NICOLE TACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
20 MEDFORD AVE STE 107B, PATCHOGUE, NY 11772-1220
(631) 902-9277
Mailing address
36 PETTY LN, MEDFORD, NY 11763-2630
(631) 902-9277
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
022292
NY
Other
Enumeration date
06/18/2019
Last updated
02/16/2021
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