Provider Demographics
NPI:1215167846
Name:ELLICOTTVILLE OASIS DAY SPA INC.
Entity type:Organization
Organization Name:ELLICOTTVILLE OASIS DAY SPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT TIMKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-699-8996
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:23 JEFFERSON ST.
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0781
Mailing Address - Country:US
Mailing Address - Phone:716-699-8996
Mailing Address - Fax:
Practice Address - Street 1:23 JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-0781
Practice Address - Country:US
Practice Address - Phone:716-699-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty