Provider Demographics
NPI:1396258158
Name:ORIENTAL HEALING OASIS & WELLNESS CENTER
Entity type:Organization
Organization Name:ORIENTAL HEALING OASIS & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINI
Authorized Official - Suffix:
Authorized Official - Credentials:MSOM, LAC
Authorized Official - Phone:262-763-9355
Mailing Address - Street 1:149 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1825
Mailing Address - Country:US
Mailing Address - Phone:262-763-9355
Mailing Address - Fax:262-342-5151
Practice Address - Street 1:149 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1825
Practice Address - Country:US
Practice Address - Phone:262-763-9355
Practice Address - Fax:262-342-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13965-146225700000X
173C00000X
WI619-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467764688OtherNPI