Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT001637 | GA |
NPI | 1013224963 |
---|---|
Provider Name | Ms. Katherine Joann Norris |
First Address | Douglas, GA 31533-2803 |
Second Address | Douglas, GA 31533-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 21/12/2010 |