Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3986-046 | WI |
NPI | 1003019035 |
---|---|
Provider Name | Katy A Kaminski |
First Address | Kaukauna, WI 54130-2022 |
Second Address | Kaukauna, WI 54130-2022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 13/08/2007 |