Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2325 | OR |
NPI | 1003281163 |
---|---|
Provider Name | Lilly Pearl Baty |
First Address | Ashland, OR 97520-1215 |
Second Address | Ashland, OR 97520-2162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2015 |
Last Update Date | 01/12/2015 |