Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20158 | OR |
NPI | 1013300870 |
---|---|
Provider Name | William Nicholas Wood |
First Address | Salem, OR 97301-3865 |
Second Address | Salem, OR 97301-3865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2015 |
Last Update Date | 17/03/2015 |