Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7338 | OR |
NPI | 1003117417 |
---|---|
Provider Name | Colleen Mcclenahan |
First Address | Portland, OR 97219-2432 |
Second Address | Portland, OR 97219-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 16/11/2010 |