Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | T59079 | OR |
NPI | 1265783518 |
---|---|
Provider Name | Tiffany Carlson |
First Address | Oregon City, OR 97045-0042 |
Second Address | West Linn, OR 97068-5101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 26/09/2012 |