Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA65758 | FL |
N | 225700000X | Massage Therapist | MT131572 | TX |
NPI | 1013274463 |
---|---|
Provider Name | Ms. Thalia Lael Micah |
First Address | Houston, TX 77063-3551 |
Second Address | Houston, TX 77063-3551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 25/06/2021 |