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General NPI Number Information
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NPI Number | 1841832029
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Entity Type | Individual
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Provider Name | MAIA CASSANDRA GADDESS LMT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 1013 LAKE ST STE 100
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City | SANDPOINT
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State | ID
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Zip | 83864-5002
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Country | US
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Telephone | 208-693-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 907 CHURCH ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1807
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Country | US
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Telephone | 208-946-3724
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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 |
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License Number State |
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