Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.010004 | OH |
NPI | 1013118819 |
---|---|
Provider Name | Tami Sue Conklin |
First Address | Toledo, OH 43617-1114 |
Second Address | Toledo, OH 43617-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356339857 | NPI (01) | OH |
33.010004 | LICENSE (01) | OH |