Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7106 | OR |
NPI | 1003106261 |
---|---|
Provider Name | Mrs. Holly Laurie Dracup-Silvonen |
First Address | Newport, OR 97365-3646 |
Second Address | Newport, OR 97365-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 08/04/2011 |