Provider Demographics
NPI:1093571762
Name:OCEAN SPRINGS THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:OCEAN SPRINGS THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOTULA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT #670
Authorized Official - Phone:228-697-8860
Mailing Address - Street 1:11420 BAYOU PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7907
Mailing Address - Country:US
Mailing Address - Phone:228-234-7131
Mailing Address - Fax:
Practice Address - Street 1:6819 WASHINGTON AVE STE F
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2181
Practice Address - Country:US
Practice Address - Phone:228-697-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty