Provider Demographics
NPI:1487079315
Name:HOOD, TIARA KEONA (BS, LMT)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:KEONA
Last Name:HOOD
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 OLD HARFORD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2886
Mailing Address - Country:US
Mailing Address - Phone:443-423-2971
Mailing Address - Fax:
Practice Address - Street 1:8700 OLD HARFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2886
Practice Address - Country:US
Practice Address - Phone:443-423-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM03711OtherLICENSED MASSAGE THERAPIST