Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 22029 | CA |
NPI | 1013516236 |
---|---|
Provider Name | Margaret Ann Wiesehan |
First Address | Newbury Park, CA 91320-2843 |
Second Address | Newbury Park, CA 91320-2843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 19/10/2020 |