Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60712839 | WA |
NPI | 1013433879 |
---|---|
Provider Name | Kristen Noelle Taylor |
First Address | Spokane Valley, WA 99206-4964 |
Second Address | Spokane Valley, WA 99206-4964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |