Individual
FANNY RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1105 INDEPENDENCE DRIVE, WEST PLAINS, MO 65775
(417) 256-0815
Mailing address
1105 INDEPENDENCE DRIVE, WEST PLAINS, MO 65775
(417) 256-0815
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2011002865
MO
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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