Individual
MS. DESIREE FREDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2627 NE BROADWAY ST, PORTLAND, OR 97232-1720
(503) 281-0278
Mailing address
1515 SE 52ND AVE, PORTLAND, OR 97215-3315
(503) 914-8500
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16509
OR
Other
Enumeration date
08/04/2010
Last updated
08/04/2010
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