Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2020027163 | MO |
N | 225700000X | Massage Therapist | 265140 | KY |
NPI | 1013529858 |
---|---|
Provider Name | Amber Nicole Squires |
First Address | Louisville, KY 40204-2287 |
Second Address | Louisville, KY 40204-2287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2020 |
Last Update Date | 22/08/2020 |