Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013233931 |
---|---|
Provider Name | Ms. Kelsey Jeanne Anderson |
First Address | Cambridge, MN 55008-1275 |
Second Address | Cambridge, MN 55008-1275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2010 |
Last Update Date | 16/04/2010 |