Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-0001879 | DE |
NPI | 1003184573 |
---|---|
Provider Name | Kari Iddings Ainsworth |
First Address | Millsboro, DE 19966-4469 |
Second Address | Millsboro, DE 19966-4469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 12/12/2011 |