Individual
MS. JASMINE LORRAINE WALLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16668
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16668
STATE LICENSE
OR
Enumeration date
10/07/2009
Last updated
10/07/2009
Update your record
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