Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 24575 | OR |
NPI | 1003441957 |
---|---|
Provider Name | Kara Deon |
First Address | Portland, OR 97209-2345 |
Second Address | Portland, OR 97209-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |