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Individual

AUTUMN L ROULAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
5835 NE DAVIS ST., PORTLAND, OR 97213-0000
(503) 231-8818
Mailing address
5835 NE DAVIS ST., PORTLAND, OR 97213
(503) 231-8818

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OBMT6906
OR

Other

Enumeration date
08/08/2011
Last updated
08/08/2011
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