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General NPI Number Information
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NPI Number | 1417546813
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Entity Type | Individual
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Provider Name | BETH IVEY
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 2288 BLUE WATER BLVD STE 440
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City | ODENTON
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State | MD
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Zip | 21113-3312
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Country | US
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Telephone | 410-674-7403
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 JASPER CT
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City | CROFTON
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State | MD
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Zip | 21114-1658
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Country | US
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Telephone | 646-327-5910
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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 | RO1833
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License Number State | MD
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