Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 14512-146 | WI |
NPI | 1013554955 |
---|---|
Provider Name | Katelyn Bjorge |
First Address | Onalaska, WI 54650-8556 |
Second Address | Onalaska, WI 54650-8556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2019 |
Last Update Date | 10/12/2019 |