Individual
BROOKE KAYLYNN SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 506-5779
Mailing address
PO BOX 428, DALLESPORT, WA 98617-0428
(509) 778-1218
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24170
OR
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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