Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13215 | OR |
NPI | 1003389248 |
---|---|
Provider Name | Sonimarie H Montgomery |
First Address | Coos Bay, OR 97420-6348 |
Second Address | Coos Bay, OR 97420-2050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 10/01/2019 |