Individual
ANNIE TANIS NICOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
141 S 3RD ST W, MISSOULA, MT 59801-2729
(406) 207-6486
Mailing address
141 S 3RD ST W, MISSOULA, MT 59801-2729
(406) 207-6486
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1015
MT
Other
Enumeration date
02/06/2011
Last updated
02/06/2011
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