Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16037 | OR |
NPI | 1013242411 |
---|---|
Provider Name | Jennifer Spears |
First Address | Ashland, OR 97520-1146 |
Second Address | Portland, OR 97202-6607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2009 |
Last Update Date | 02/10/2009 |