Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 101451 | AK |
NPI | 1003203217 |
---|---|
Provider Name | Meranda Spaulding |
First Address | Wasilla, AK 99687-5263 |
Second Address | Wasilla, AK 99654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2015 |
Last Update Date | 03/01/2019 |