Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 330 | MT |
NPI | 1003206814 |
---|---|
Provider Name | Donna Heisel |
First Address | Charlo, MT 59824-9391 |
Second Address | Charlo, MT 59824-9391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2015 |
Last Update Date | 01/02/2015 |