Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT4704 | ME |
NPI | 1003166794 |
---|---|
Provider Name | Alison Marie Mason |
First Address | Portland, ME 04103-3933 |
Second Address | Portland, ME 04103-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 11/09/2012 |