Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 25954 | OR |
NPI | 1003414269 |
---|---|
Provider Name | Carlee Nicole Demore |
First Address | Sunriver, OR 97707-2158 |
Second Address | Sunriver, OR 97707-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2020 |
Last Update Date | 10/10/2020 |