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General NPI Number Information
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NPI Number | 1699337311
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Entity Type | Individual
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Provider Name | GENEA RENEA LITTLE MMP, LMT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 210 E LINCOLN ST
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City | HAMBURG
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State | AR
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Zip | 71646-3218
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Country | US
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Telephone | 870-831-5066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | HAMBURG
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State | AR
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Zip | 71646-0518
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Country | US
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Telephone | 870-831-5066
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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 | LA8646
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License Number State | LA
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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 | 8485
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License Number State | AR
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