Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11061-46 | WI |
NPI | 1013296276 |
---|---|
Provider Name | Mr. Nathan Wade Schlieve |
First Address | Eau Claire, WI 54701-6479 |
Second Address | Eau Claire, WI 54701-6479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 05/08/2011 |