Provider Demographics
NPI:1609278811
Name:ICHI, ACHESEOPALIMA (LPN, CMT)
Entity Type:Individual
Prefix:
First Name:ACHESEOPALIMA
Middle Name:
Last Name:ICHI
Suffix:
Gender:F
Credentials:LPN, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WATERWOOD PKWY
Mailing Address - Street 2:STE. G, UNIT G-1
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 WATERWOOD PKWY
Practice Address - Street 2:STE. G, UNIT G-1
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5327
Practice Address - Country:US
Practice Address - Phone:866-755-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist