Individual
STACY MICHELLE WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
991 GRAND CAILLOU RD BLDG 2, HOUMA, LA 70363-5705
(985) 860-9693
Mailing address
112 GLENHILL DR, HOUMA, LA 70363-3811
(985) 860-9693
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA6837
LA
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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