Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | ID |
NPI | 1003258104 |
---|---|
Provider Name | Mrs. Terri R Dahmer |
First Address | Coeur D Alene, ID 83815-6355 |
Second Address | Post Falls, ID 83854-6731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 22/11/2015 |