Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 530489-07 | MI |
Y | 225700000X | Massage Therapist | 7501000286 | MI |
NPI | 1013227560 |
---|---|
Provider Name | Ms. Dianna R Tait |
First Address | Ypsilanti, MI 48198-9490 |
Second Address | Ypsilanti, MI 48198-9490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 22/08/2016 |