Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 4824-146 | WI |
NPI | 1013341288 |
---|---|
Provider Name | Carmen Webb |
First Address | Wisconsin Rapids, WI 54494-4622 |
Second Address | Wisconsin Rapids, WI 54494-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2013 |
Last Update Date | 23/08/2013 |