Provider Demographics
NPI:1780856070
Name:MEDICAL MASSAGE OF DELAWARE
Entity Type:Organization
Organization Name:MEDICAL MASSAGE OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGILVIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN-CMT
Authorized Official - Phone:302-571-9075
Mailing Address - Street 1:2309 W 17TH
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-571-9075
Mailing Address - Fax:970-204-6812
Practice Address - Street 1:2309 W 17TH
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-571-9075
Practice Address - Fax:970-204-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON/A305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service