Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 006812 | IA |
NPI | 1003205840 |
---|---|
Provider Name | Catherine Ott |
First Address | Cedar Falls, IA 50613-2859 |
Second Address | Cedar Falls, IA 50613-2859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2015 |
Last Update Date | 16/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0665380 | (05) | IA |