Individual
MS. AMANDA GAIL STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
463D OLD BLUEFIELD RD, PRINCETON, WV 24740-8927
(304) 952-2942
Mailing address
463D OLD BLUEFIELD RD, PRINCETON, WV 24740-8927
(304) 952-2942
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20102705
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010-2705
STATE LICENSE NUMBER
WV
Enumeration date
07/01/2010
Last updated
07/01/2010
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