NPI | 1932671682 |
---|---|
Former Name | KARA LOUISE SUPPES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501011321) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
225800000X Recreation Therapist | |
Enumeration Date | 2018-12-19 |
Last Update Date | 2024-03-15 |