Provider Demographics
NPI:1700308210
Name:OPEN SKY WELLNESS, LLC
Entity Type:Organization
Organization Name:OPEN SKY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-376-2256
Mailing Address - Street 1:7383 UTICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-9503
Mailing Address - Country:US
Mailing Address - Phone:315-376-2256
Mailing Address - Fax:
Practice Address - Street 1:7383 UTICA BLVD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-9503
Practice Address - Country:US
Practice Address - Phone:315-376-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty