Individual
HOLLY RAE ST.LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NTP, CPT, CFG
Contact information
Practice address
566 HORN LN, EUGENE, OR 97404-2961
(541) 636-3856
Mailing address
566 HORN LN, EUGENE, OR 97404-2961
(541) 636-3856
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
0800
WA
172M00000X
Mechanotherapist
1344664
CA
175F00000X
Naturopath
656619
OR
Other
Enumeration date
03/14/2011
Last updated
03/14/2011
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