Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 19889 | OR |
NPI | 1013335645 |
---|---|
Provider Name | Christina Estrada |
First Address | Salem, OR 97304-3762 |
Second Address | Salem, OR 97302-3159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 01/04/2014 |