Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 26198 | OR |
NPI | 1013661768 |
---|---|
Provider Name | Caitlin Couture |
First Address | Portland, OR 97220-5459 |
Second Address | Portland, OR 97214-4673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |