Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003322173 |
---|---|
Provider Name | Stephanie Molina |
First Address | Bend, OR 97703-3200 |
Second Address | Bend, OR 97703-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2017 |
Last Update Date | 27/12/2017 |