Provider Demographics
NPI:1538458435
Name:MOLODTSOVA, OLGA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:MOLODTSOVA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2115
Mailing Address - Country:US
Mailing Address - Phone:248-390-2162
Mailing Address - Fax:
Practice Address - Street 1:3703 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2115
Practice Address - Country:US
Practice Address - Phone:248-390-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No172M00000XOther Service ProvidersMechanotherapist