Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2017-3570 | WV |
NPI | 1013407691 |
---|---|
Provider Name | Brandi Raelynn Krismer |
First Address | Huntington, WV 25702-1417 |
Second Address | Milton, WV 25541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |