Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 101927 | AK |
NPI | 1013376946 |
---|---|
Provider Name | Tiffany Stacey |
First Address | Auke Bay, AK 99821-1231 |
Second Address | Juneau, AK 99801-1083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2016 |
Last Update Date | 23/02/2016 |