Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | #205 | MA |
N | 225700000X | Massage Therapist | #6783 | MA |
NPI | 1013291137 |
---|---|
Provider Name | Ms. Paula Jean Miele |
First Address | Brookline, MA 02446 |
Second Address | Brookline, MA 02446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2011 |
Last Update Date | 07/10/2011 |