Individual
MS. KELLY AUSTIN MCCLUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
314 NE 19TH AVE, PORTLAND, OR 97232-2829
(305) 304-2319
Mailing address
314 NE 19TH AVE, PORTLAND, OR 97232-2829
(305) 304-2319
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22293
OR
Other
Enumeration date
08/18/2016
Last updated
08/18/2016
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