Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT.0020585 | CO |
NPI | 1003323866 |
---|---|
Provider Name | Tabitha Clotiaux |
First Address | Broomfield, CO 80020-1879 |
Second Address | Broomfield, CO 80020-1879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2018 |
Last Update Date | 02/01/2018 |