Individual
ATHEENA DAWN WALTERS NIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
207 BLANCHARD AVENUE, OTTAWA, OH 45875
(419) 889-1047
Mailing address
207 BLANCHARD AVENUE, OTTAWA, OH 45875
(419) 889-1047
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33-015503
OH
Other
Enumeration date
04/10/2008
Last updated
04/10/2008
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