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Individual

SAMANTHA LEE KOCIEMBA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1755 17TH AVE E, SHAKOPEE, MN 55379-3372
(952) 445-5250
Mailing address
1755 17TH AVE E, SHAKOPEE, MN 55379-3372
(952) 445-5250
(952) 445-5350

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1356513592
MASSAGE
MN
Enumeration date
10/30/2018
Last updated
10/30/2018
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