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General NPI Number Information
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NPI Number | 1700146164
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Entity Type | Individual
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Provider Name | GWENDA MCCLAIN HARRISON LMT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 05/19/2012
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Provider Practice Location Address
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Address Line | 10903 INDIAN HEAD HWY SUITE 303
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City | FT WASHINGTON
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State | MD
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Zip | 20744-4000
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Country | US
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Telephone | 301-509-7249
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Fax |
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Provider Business Mailing Address
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Address Line | 15313 LIVINGSTON RD
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City | ACCOKEEK
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State | MD
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Zip | 20607-2819
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Country | US
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Telephone | 301-509-7249
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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 | 02737
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License Number State | MD
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