Provider Demographics
NPI:1427748524
Name:ONELOVE, AUTUMN ANASTASIA
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ANASTASIA
Last Name:ONELOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3005
Mailing Address - Country:US
Mailing Address - Phone:715-256-7592
Mailing Address - Fax:715-814-9621
Practice Address - Street 1:1349 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3005
Practice Address - Country:US
Practice Address - Phone:715-256-7592
Practice Address - Fax:715-814-9621
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17186-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist