Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2019021944 | MO |
NPI | 1013676824 |
---|---|
Provider Name | Amber Mcdowell |
First Address | Carl Junction, MO 64834-9181 |
Second Address | Joplin, MO 64801-9753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |