Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60544258 | WA |
NPI | 1013304856 |
---|---|
Provider Name | Miss Rachel Nadine Percell |
First Address | Portland, OR 97203-5839 |
Second Address | Portland, OR 97203-5839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |