Individual
AMITY MEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2476 NW NORTHRUP ST, SUITE 2A, PORTLAND, OR 97210-3133
(503) 704-0579
Mailing address
3003 SE 43RD AVE, PORTLAND, OR 97206-3101
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT 12879
OR
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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