Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MM32542 | FL |
NPI | 1013564400 |
---|---|
Provider Name | Kathleen Suzanne Jansen |
First Address | Apalachicola, FL 32320-1753 |
Second Address | Apalachicola, FL 32320-1470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2019 |
Last Update Date | 21/08/2019 |