Individual
MRS. KENDRA LEE BOHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
15579 SW 76TH AVE, TIGARD, OR 97224-7980
(971) 219-6427
Mailing address
15579 SW 76TH AVE, TIGARD, OR 97224-7980
(971) 219-6427
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10828
OR
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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