Individual
BAYLEE MELCINE BOUSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
114 E HANCOCK ST, NEWBERG, OR 97132-2822
(503) 554-0661
Mailing address
4709 NE 41ST ST, VANCOUVER, WA 98661-8808
(360) 713-4881
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-23832
OR
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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