Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11223 | MA |
NPI | 1013252600 |
---|---|
Provider Name | Laci Maira Parker |
First Address | Great Barrington, MA 01230-1773 |
Second Address | Great Barrington, MA 01230-1773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |