Individual
ROXANNE M WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6186 W MAINE ST., SPIRIT LAKE, ID 83869
(208) 651-2298
(208) 623-6717
Mailing address
PO BOX 1133, SPIRIT LAKE, ID 83869-1133
(208) 651-2298
(208) 623-6717
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-13
ID
Other
Enumeration date
04/28/2014
Last updated
04/30/2014
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