Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1101042 | MA |
NPI | 1013330166 |
---|---|
Provider Name | Debra Kizilcan |
First Address | Charlton, MA 01507-5430 |
Second Address | Sturbridge, MA 01566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 29/01/2014 |