Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 17953 | OR |
NPI | 1013294388 |
---|---|
Provider Name | Jon Mclaughlin |
First Address | Talent, OR 97540-1374 |
Second Address | Ashland, OR 97520-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 14/11/2011 |