Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 018483 | NY |
NPI | 1003320482 |
---|---|
Provider Name | Sara Elisabeth Mayer Mckernan |
First Address | Williamsville, NY 14221-7108 |
Second Address | Cheektowaga, NY 14215-1954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 21/11/2017 |