Individual
KALESH WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7676 ADAMS RD, TALENT, OR 97540-7839
(541) 535-3890
Mailing address
312 EAST MAIN STREET, TALENT, OR 97540
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16981
OR
Other
Enumeration date
08/14/2012
Last updated
08/14/2012
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