Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT033515 | TX |
NPI | 1023135688 |
---|---|
Provider Name | Ms. Lynette Faye Ring |
First Address | Ada, OK 74821-0041 |
Second Address | Ada, OK 74820-1048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 04/12/2012 |