Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.023067 | OH |
NPI | 1013463553 |
---|---|
Provider Name | Shakira Taylor |
First Address | Columbus, OH 43203-1002 |
Second Address | Columbus, OH 43209-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2016 |
Last Update Date | 25/08/2016 |