Olivia Nicole Bounthanom

NPI #1235642034 in Jber, Alaska

Provider Information

NPI Number: 1235642034
Entity Type: Individual
Name: Olivia Nicole Bounthanom
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Enumeration Date: Nov 15, 2017
Last Updated: Nov 15, 2017

Practice Location

Address: 4110 BULLARD AVE UNIT B
City: Jber
State: Alaska
ZIP Code: 99506-1406
Phone: (907) 351-8383

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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