Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2008009697 | MO |
NPI | 1003135559 |
---|---|
Provider Name | Molly Ann Calandro |
First Address | Fenton, MO 63026-4129 |
Second Address | Fenton, MO 63026-4129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 24/05/2010 |