Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13835 | OR |
NPI | 1013268515 |
---|---|
Provider Name | Marjo Aardema |
First Address | Lebanon, OR 97355-4104 |
Second Address | Lebanon, OR 97355-3338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |