Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 25007 | OR |
NPI | 1013508837 |
---|---|
Provider Name | Julia Mccoy |
First Address | Trail, OR 97541-9624 |
Second Address | Medford, OR 97501-5923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2021 |
Last Update Date | 02/09/2021 |