Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 58230 | FL |
NPI | 1013235332 |
---|---|
Provider Name | Heather Olson |
First Address | Gainesville, FL 32609-3531 |
Second Address | Gainesville, FL 32609-3531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2010 |
Last Update Date | 11/05/2010 |