Individual
CAROL R MATHRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1154 COMMERCIAL ST, ASTORIA, OR 97103-4126
(503) 440-3664
Mailing address
41991 MEYER LN, ASTORIA, OR 97103-8428
(503) 440-3664
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11681
OR
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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