Healthcare Provider Details

I. General information

NPI: 1114236874
Provider Name (Legal Business Name): CAROL R. DAGGS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 STATE ST 2ND FL.
SPRINGFIELD MA
01103-1987
US

IV. Provider business mailing address

135 STATE ST 2ND FL.
SPRINGFIELD MA
01103-1987
US

V. Phone/Fax

Practice location:
  • Phone: 413-563-9541
  • Fax:
Mailing address:
  • Phone: 413-563-9541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: