Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 18002 | OH |
NPI | 1013599422 |
---|---|
Provider Name | Kristen Sarah Anderson |
First Address | Spencer, OH 44275-0275 |
Second Address | Medina, OH 44256-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2021 |
Last Update Date | 25/04/2021 |