Individual
BRENDA KAY KILLINGSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
14925 SW 133RD AVE, TIGARD, OR 97224-1604
(503) 307-9894
Mailing address
14925 SW 133RD AVE, TIGARD, OR 97224-1604
(503) 307-9894
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15772
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15772
OREGON MASSAGE BOARD
OR
Enumeration date
03/25/2009
Last updated
03/25/2009
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