=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033531751
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIELLE HAIR LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2014
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 N WILSON RD
-----------------------------------------------------
City | RADCLIFF
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40160-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-932-3322
-----------------------------------------------------
Fax | 941-827-8283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 347 N WILSON RD
-----------------------------------------------------
City | RADCLIFF
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40160-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-932-3322
-----------------------------------------------------
Fax | 941-827-8283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | KY-5044
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------