Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA60169177 | WA |
Y | 225700000X | Massage Therapist | MASG1964 | ID |
NPI | 1013458660 |
---|---|
Provider Name | Shannon N Cox |
First Address | Hayden Lake, ID 83835-9154 |
Second Address | Hayden Lake, ID 83835-9154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |