Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA52045 | FL |
NPI | 1003091547 |
---|---|
Provider Name | Nicole Celeste Oliver |
First Address | Brandon, FL 33511-4854 |
Second Address | Brandon, FL 33511-4854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 03/01/2008 |