Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 12552 | OR |
NPI | 1003184847 |
---|---|
Provider Name | Joelle Anne Cappello |
First Address | Portland, OR 97212-5310 |
Second Address | Portland, OR 97212-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 08/12/2011 |