=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821230426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE WELLNESS - BAERTA CLARE GRAFF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2009
-----------------------------------------------------
Last Update Date | 04/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 EATON STREET
-----------------------------------------------------
City | CENTRAL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29630-9112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-506-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 EATON ST
-----------------------------------------------------
City | CENTRAL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29630-9112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-506-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. BAERTA CLARE GRAFF
-----------------------------------------------------
Credential | LMT, BSED, NCTMB
-----------------------------------------------------
Telephone | 864-506-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 1796
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA002912
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------