=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629300736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON NOLAND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2010
-----------------------------------------------------
Last Update Date | 02/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 AMERICAN LEGION BLVD
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-587-4244
-----------------------------------------------------
Fax | 208-580-2223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1821 NE SUMMERWIND DR
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83647-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-421-0504
-----------------------------------------------------
Fax | 208-580-2223
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------