Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 21750 | OR |
NPI | 1003274010 |
---|---|
Provider Name | Mrs. Jessica Cabac |
First Address | Happy Valley, OR 97086-5895 |
Second Address | Gresham, OR 97030-5569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2016 |
Last Update Date | 21/03/2016 |