Individual
OCTAVIA ELAYNE MCKENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3577 MAIN STATION DR SW, MARIETTA, GA 30008-6054
(678) 869-1250
Mailing address
3577 MAIN STATION DR SW, MARIETTA, GA 30008-6054
(678) 869-1250
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT011404
GA
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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