Provider Demographics
NPI:1629209705
Name:TUSCAN SUN SPA
Entity Type:Organization
Organization Name:TUSCAN SUN SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:304-637-1820
Mailing Address - Street 1:482 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5514
Mailing Address - Country:US
Mailing Address - Phone:304-326-2204
Mailing Address - Fax:
Practice Address - Street 1:482 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5514
Practice Address - Country:US
Practice Address - Phone:304-637-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2002-0948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty