Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | BMTMTH00220860 | KY |
NPI | 1184008880 |
---|---|
Provider Name | Ms. Samantha Noel Jaggers |
First Address | New Castle, KY 40050-6743 |
Second Address | New Castle, KY 40050-6743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2015 |
Last Update Date | 13/07/2015 |