Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 5218 | OR |
NPI | 1013347657 |
---|---|
Provider Name | Barbara Werner |
First Address | Beaverton, OR 97006-3563 |
Second Address | Beaverton, OR 97006-3563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 18/11/2013 |