Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003475484 |
---|---|
Provider Name | Rachel E Gothard-Gollob |
First Address | Centralia, WA 98531-4252 |
Second Address | Centralia, WA 98531-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/06/2019 |