Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 22105 | OR |
NPI | 1013360346 |
---|---|
Provider Name | Heather Kaplan |
First Address | Portland, OR 97215-1046 |
Second Address | Portland, OR 97214-3578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 21/07/2016 |