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General NPI Number Information
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NPI Number | 1619889607
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Entity Type | Individual
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Provider Name | WYNONNA CLINE LMT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 205 N MAIN ST
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City | STANTON
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State | KY
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Zip | 40380-2175
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Country | US
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Telephone | 502-667-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 435 OAK RIDGE RD
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City | CLAY CITY
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State | KY
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Zip | 40312-9048
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Country | US
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Telephone | 502-667-0568
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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 | 310661
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License Number State | KY
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