Individual
CAROLINE DEJEN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1928 NE 40TH AVE, PORTLAND, OR 97212-5310
(503) 287-2787
Mailing address
1589 S CHERRY ST, CORNELIUS, OR 97113-7412
(503) 860-7304
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16590
OR
Other
Enumeration date
11/22/2011
Last updated
11/22/2011
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