Individual
MISS BREEONA M WAUTLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1315 MARIPOSA ST, DENVER, CO 80204-2500
(720) 629-0258
Mailing address
1315 MARIPOSA ST, DENVER, CO 80204-2500
(720) 629-0258
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11914
CO
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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