Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227013125 | IL |
NPI | 1013315829 |
---|---|
Provider Name | Mrs. Stephanie Morgan Taylor |
First Address | Cambridge, IL 61238-1402 |
Second Address | Cambridge, IL 61238-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2014 |
Last Update Date | 10/12/2014 |