Healthcare Provider Details

I. General information

NPI: 1861894792
Provider Name (Legal Business Name): TABATHA SNYDER CLMMMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 NE WOODS CHAPEL RD
LEES SUMMIT MO
64064-1900
US

IV. Provider business mailing address

617 NE WOODS CHAPEL RD
LEES SUMMIT MO
64064-1900
US

V. Phone/Fax

Practice location:
  • Phone: 913-961-4677
  • Fax:
Mailing address:
  • Phone: 913-961-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2007028967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: