Individual
EDA DANIELLE DEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
408 VINE ST, POPLAR BLUFF, MO 63901-5838
(573) 686-1118
(573) 686-5109
Mailing address
408 VINE ST, POPLAR BLUFF, MO 63901-5838
(573) 686-1118
(573) 686-5109
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2004020981
MO
Other
Enumeration date
11/25/2014
Last updated
11/25/2014
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