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General NPI Number Information
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NPI Number | 1881092492
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Entity Type | Individual
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Provider Name | LAURIE HIGGINBOTHAM
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Gender | Female
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 512 WESTLINE DR STE 204
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City | ALAMEDA
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State | CA
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Zip | 94501-7605
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Country | US
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Telephone | 510-301-4027
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Fax | 510-550-7009
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Provider Business Mailing Address
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Address Line | 1029 TAHITI LN
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City | ALAMEDA
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State | CA
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Zip | 94502-6930
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Country | US
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Telephone | 510-301-4027
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Fax | 510-550-7009
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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 | 11971
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License Number State | CA
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