Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16454 | OR |
NPI | 1003144759 |
---|---|
Provider Name | Mrs. Ariel Zimmer |
First Address | Dallas, OR 97338-3413 |
Second Address | Dallas, OR 97338-1908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2009 |
Last Update Date | 29/01/2022 |