Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | DH7097 | FL |
Y | 225700000X | Massage Therapist | MA41530 | FL |
NPI | 1033486576 |
---|---|
Provider Name | Susan R Higley |
First Address | Pinellas Park, FL 33781-5217 |
Second Address | Pinellas Park, FL 33781-3440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 04/08/2014 |