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General NPI Number Information
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NPI Number | 1356051064
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Entity Type | Individual
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Provider Name | JOEL DOUGLAS FIELDS LMT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 3442 STELLHORN RD
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City | FORT WAYNE
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State | IN
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Zip | 46815-4630
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Country | US
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Telephone | 419-439-3745
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Fax |
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Provider Business Mailing Address
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Address Line | 12705 ROAD 162
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City | PAULDING
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State | OH
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Zip | 45879-8825
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Country | US
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Telephone | 419-439-3745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.022928
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT21605787
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License Number State | IN
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