Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2005-1913 | WV |
NPI | 1003024837 |
---|---|
Provider Name | Amanda K Hager |
First Address | Shoals, WV 25562-0029 |
Second Address | Huntington, WV 25701-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |