Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 19314 | OR |
NPI | 1013268762 |
---|---|
Provider Name | Ann Janelle Holland |
First Address | Dallas, OR 97338-9478 |
Second Address | Dallas, OR 97338-1580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 20/09/2012 |