Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | KY-2551 | KY |
NPI | 1013234558 |
---|---|
Provider Name | Martha N Rayborn |
First Address | Salvisa, KY 40372-9738 |
Second Address | Salvisa, KY 40372-9738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 23/04/2010 |