Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.018845 | OH |
NPI | 1003458118 |
---|---|
Provider Name | Cecilia Marie Teaford |
First Address | Gallipolis, OH 45631-1637 |
Second Address | Gallipolis, OH 45631-1637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |