Healthcare Provider Details

I. General information

NPI: 1598138083
Provider Name (Legal Business Name): JOYCE MAYNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 6TH STREET WEST SUITE 7
CEREDO WV
25507
US

IV. Provider business mailing address

303 6TH STREET WEST
CEREDO WV
25507
US

V. Phone/Fax

Practice location:
  • Phone: 304-654-1612
  • Fax:
Mailing address:
  • Phone: 304-654-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: