Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 8207225-4701 | UT |
NPI | 1013660315 |
---|---|
Provider Name | Charles Matthew Oakley |
First Address | West Valley City, UT 84119-4326 |
Second Address | West Valley City, UT 84119-4326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2022 |
Last Update Date | 27/01/2022 |