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General NPI Number Information
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NPI Number | 1972231835
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Entity Type | Individual
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Provider Name | HAILEY NICOLE SPRAGUE LMT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 604 STATE ST
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City | MOUND CITY
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State | MO
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Zip | 64470-1147
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Country | US
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Telephone | 816-273-7542
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Fax |
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Provider Business Mailing Address
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Address Line | 35061 HOLT 285
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City | OREGON
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State | MO
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Zip | 64473-8293
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Country | US
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Telephone | 816-273-7542
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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 | 2021008097
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License Number State | MO
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