Individual
TAMIKA RAYCHAUN FAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
551 LLOYD LN, SHREVEPORT, LA 71106-4742
(318) 517-2091
Mailing address
551 LLOYD LN, SHREVEPORT, LA 71106-4742
(318) 517-2091
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA6881
LA
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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