Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15961 | OR |
NPI | 1013299643 |
---|---|
Provider Name | Maria Hartrum |
First Address | Lebanon, OR 97355-4541 |
Second Address | Lebanon, OR 97355-3139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 09/09/2011 |