Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 023403 | OR |
NPI | 1013413715 |
---|---|
Provider Name | Danielle C Becraft |
First Address | Springfield, OR 97477 |
Second Address | Springfield, OR 97477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 06/12/2019 |