Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2006028295 | MO |
NPI | 1003141789 |
---|---|
Provider Name | Mrs. Debra Kay Hall |
First Address | Cassville, MO 65625-1419 |
Second Address | Cassville, MO 65625-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2009 |
Last Update Date | 13/10/2009 |