Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013204494 |
---|---|
Provider Name | Diane Marie Pierce |
First Address | Gorham, ME 04038 |
Second Address | Gorham, ME 04038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 06/07/2011 |