MEDICARE: MRS. VERONICA LATHAM-EMERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	AK6930473	AK

General Provider Information

NPI Number	:	1679107072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA LATHAM-EMERSON

Provider Business Mailing Address
First Line	:	1773 COLLEGE RD
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-4176
Country	:	US
Telephone Number	:	907-457-5100
Fax Number	:	907-457-5102

Provider Business Practice Location Address
First Line	:	1773 COLLEGE RD
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-4176
Country	:	US
Telephone Number	:	907-457-5100
Fax Number	:	907-457-5102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/25/2020

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