Provider Demographics
NPI:1801368642
Name:GONSETH, JOELLIE MARIE (BS, LMT)
Entity Type:Individual
Prefix:
First Name:JOELLIE
Middle Name:MARIE
Last Name:GONSETH
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:JOELLIE
Other - Middle Name:MARIE
Other - Last Name:GONSETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, LMT
Mailing Address - Street 1:PO BOX 5115
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-5115
Mailing Address - Country:US
Mailing Address - Phone:352-875-5515
Mailing Address - Fax:352-355-1504
Practice Address - Street 1:307 NE 12TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5911
Practice Address - Country:US
Practice Address - Phone:352-875-5515
Practice Address - Fax:352-355-1504
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist