Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 019660 | OH |
NPI | 1003167917 |
---|---|
Provider Name | Sharon M Fish |
First Address | Willowick, OH 44095-3222 |
Second Address | Lyndhurst, OH 44124-3719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 02/10/2012 |