Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 14718 | OR |
NPI | 1013157585 |
---|---|
Provider Name | Miss Kristy Lee Lemmon |
First Address | Independence, OR 97351-2044 |
Second Address | Independence, OR 97351-2044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2009 |
Last Update Date | 16/07/2011 |