Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16697 | OR |
NPI | 1003154840 |
---|---|
Provider Name | Jasmine R Craven |
First Address | Warrenton, OR 97146-0762 |
Second Address | Astoria, OR 97103-4061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 29/01/2013 |