Provider Demographics
NPI:1801397674
Name:LITTLE, INESSA A (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:A
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 SEAFARER LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3554
Mailing Address - Country:US
Mailing Address - Phone:907-538-5931
Mailing Address - Fax:
Practice Address - Street 1:404 K ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2016
Practice Address - Country:US
Practice Address - Phone:907-222-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist