Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 87735 | |
N | 225700000X | Massage Therapist | 87735 | CA |
NPI | 1003585068 |
---|---|
Provider Name | Karli Nicole Freeland |
First Address | Folsom, CA 95630-5162 |
Second Address | Folsom, CA 95630-5162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2021 |
Last Update Date | 12/09/2021 |