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General NPI Number Information
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NPI Number | 1548915846
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Entity Type | Individual
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Provider Name | DANIELLE COLENE CLAYCOMB LMT
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 3759 BUSINESS 220 STE 101
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City | BEDFORD
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State | PA
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Zip | 15522-1130
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Country | US
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Telephone | 814-977-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 412 1/2 EAST PITT STEET
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City | BEDFORD
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State | PA
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Zip | 15522
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Country | US
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Telephone | 814-977-9035
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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 | MSG012717
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License Number State | PA
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