Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 8184 | MA |
NPI | 1013234384 |
---|---|
Provider Name | Anne Poulin |
First Address | Belmont, MA 02478-4401 |
Second Address | Belmont, MA 02478-4401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 27/04/2010 |