Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 018426-1 | NY |
NPI | 1003212671 |
---|---|
Provider Name | Elizabeth Pakenham |
First Address | West Seneca, NY 14224-3625 |
Second Address | West Seneca, NY 14218-3785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 10/11/2014 |