Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 288818-00 | CA |
NPI | 1013491497 |
---|---|
Provider Name | Kathleen Lynn Chandler |
First Address | Bishop, CA 93514 |
Second Address | Bishop, CA 93514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |