Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10572 | TN |
NPI | 1003317868 |
---|---|
Provider Name | Susan Annette Oliver |
First Address | Kingsport, TN 37660-3224 |
Second Address | Kingsport, TN 37660-4245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |