Individual
TABITHA RENEE BOAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3150 BUSH LN, DALZELL, SC 29040-9724
(540) 589-4248
Mailing address
3150 BUSH LN, DALZELL, SC 29040-9724
(540) 589-4248
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8291
SC
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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