Individual
JESSICA LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2405 SE CRYSTAL LAKE DR, CORVALLIS, OR 97333-2014
(917) 679-7296
Mailing address
2405 SE CRYSTAL LAKE DR, CORVALLIS, OR 97333-2014
(917) 679-7296
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23819
OR
Other
Enumeration date
01/22/2021
Last updated
01/10/2022
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