Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20223 | OR |
NPI | 1013389527 |
---|---|
Provider Name | Ms. Carol Delima |
First Address | Milwaukie, OR 97222-9707 |
Second Address | Milwaukie, OR 97222-9707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 22/10/2015 |