Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 015590 | NY |
NPI | 1013339647 |
---|---|
Provider Name | Melissa Goff |
First Address | Kenmore, NY 14217-2924 |
Second Address | Kenmore, NY 14217-2924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 16/01/2014 |