Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6098 | OR |
NPI | 1003113481 |
---|---|
Provider Name | Barbara Susan Dieringer |
First Address | Tigard, OR 97223-2872 |
Second Address | Tigard, OR 97223-2872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2011 |
Last Update Date | 19/02/2011 |