Provider Demographics
NPI:1588308878
Name:O SO RELAXED
Entity type:Organization
Organization Name:O SO RELAXED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:OTHELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:757-563-3377
Mailing Address - Street 1:PO BOX 65585
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23467-5585
Mailing Address - Country:US
Mailing Address - Phone:757-563-3377
Mailing Address - Fax:
Practice Address - Street 1:880 JAMESTOWN LANDING RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4009
Practice Address - Country:US
Practice Address - Phone:757-563-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty