Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2009000045 | MO |
NPI | 1013539923 |
---|---|
Provider Name | Mrs. Deborah Leann Inman |
First Address | Aurora, MO 65605-5283 |
Second Address | Aurora, MO 65605-5283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2020 |
Last Update Date | 13/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2009000045 | MISSOURI MASSAGE THERAPIST LICENSE (01) | MO |
2013007195 | MISSOURI MASSAGE THERAPY BUSINESS LICENSE (01) | MO |