Individual
KELLY ANN STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2167 NW 185TH AVE, HILLSBORO, OR 97124-7074
(503) 336-3456
Mailing address
1612 NE PARKSIDE DR, HILLSBORO, OR 97124-3925
(503) 857-9504
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11440
OR
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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