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General NPI Number Information
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NPI Number | 1841693017
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Entity Type | Individual
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Provider Name | TAMARA R CLINE LMT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 3534 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9054
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Country | US
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Telephone | 304-553-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 110 GREENBRIER DR
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City | SCOTT DEPOT
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State | WV
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Zip | 25560-9699
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Country | US
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Telephone | 304-553-1096
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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 | 2012-2937
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License Number State | WV
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