Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11206 | OR |
NPI | 1013312347 |
---|---|
Provider Name | Ms. Annabeth R Nelson |
First Address | Silverton, OR 97381-2211 |
Second Address | Silverton, OR 97381-2243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 29/10/2014 |