Individual
BETHANY ELISE BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
201 S 2ND ST, STILWELL, OK 74960-3838
(918) 575-1151
Mailing address
465436 E 783 RD, STILWELL, OK 74960-6075
(918) 575-1151
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1056678
OK
Other
Enumeration date
03/01/2024
Last updated
03/01/2024
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