Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | CO |
NPI | 1013497494 |
---|---|
Provider Name | Deborah Kelly Schenk |
First Address | Lakewood, CO 80232-5454 |
Second Address | Lakewood, CO 80232-5454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |