Individual
MS. KRISTEL EDEN WONDERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3276 COMMERCIAL ST SE, SALEM, OR 97302-4584
(503) 749-2199
Mailing address
1945 GARFIELD ST NE, SALEM, OR 97301-8153
(503) 749-2199
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
Primary
11433
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11433
MASSAGE THERAPIST LICENSE
OR
Enumeration date
08/19/2008
Last updated
08/19/2008
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