Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.023810 | OH |
NPI | 1013425644 |
---|---|
Provider Name | Autumn Rose Hastedt |
First Address | Hamler, OH 43524-9766 |
Second Address | Napoleon, OH 43545-9194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 17/01/2018 |