Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | M00481 | MD |
NPI | 1013237643 |
---|---|
Provider Name | Mrs. Lizabeth Ann Smull |
First Address | Columbia, MD 21045-3209 |
Second Address | Ellicott City, MD 21042-7829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2010 |
Last Update Date | 05/06/2010 |