Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 28886 | FL |
NPI | 1255660213 |
---|---|
Provider Name | Kelli Mirr |
First Address | Hollywood, FL 33021-2823 |
Second Address | Hollywood, FL 33021-2823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2009 |
Last Update Date | 21/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA 28886 | LICENSE MASSAGE THERAPIST (01) | FL |