Individual
OLIVIA WYCOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4512 SE WOODSTOCK BLVD, PORTLAND, OR 97206-6274
(503) 777-2776
Mailing address
7025 NE 8TH AVE, PORTLAND, OR 97211-3523
(920) 284-0293
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15225
OR
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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