Provider Demographics
NPI:1578131421
Name:NICKOLAS EUGENE GREEN
Entity Type:Organization
Organization Name:NICKOLAS EUGENE GREEN
Other - Org Name:OHM MASSAGE & BODY WORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-223-4128
Mailing Address - Street 1:1090 SE PIONEER WAY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5743
Mailing Address - Country:US
Mailing Address - Phone:253-223-4128
Mailing Address - Fax:360-323-4151
Practice Address - Street 1:520 E WHIDBEY AVE STE 103
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5921
Practice Address - Country:US
Practice Address - Phone:253-223-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty