NPI | 1154706109 |
---|---|
Former Name | KELLY JANEL HOWARD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225700000X Massage Therapist (Licence: OR OBMT21306) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 21306) |
Enumeration Date | 2015-07-20 |
Last Update Date | 2019-02-25 |