Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60217360 | WA |
NPI | 1003103748 |
---|---|
Provider Name | Chantalle Sarah D'spain |
First Address | Spokane, WA 99223-7040 |
Second Address | Spokane, WA 99223-7040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/07/2011 |