| NPI | 1700374618 |
|---|---|
| Former Name | TELECIA BOUTWELL ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA90478) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M05790) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-10-09 |