Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60202682 | WA |
NPI | 1013200799 |
---|---|
Provider Name | Laura Rae Copley |
First Address | Portland, OR 97203-2668 |
Second Address | Portland, OR 97203-2668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2011 |
Last Update Date | 27/05/2011 |