Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 008908-01 | NY |
NPI | 1013104413 |
---|---|
Provider Name | Mrs. Judith Ann Little |
First Address | Lancaster, NY 14086-2603 |
Second Address | Depew, NY 14043-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 28/09/2007 |