Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10454 | OR |
NPI | 1013319029 |
---|---|
Provider Name | Aurora Martinez |
First Address | Gladstone, OR 97027-2510 |
Second Address | Gladstone, OR 97027-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 22/09/2014 |