Individual
DEDRA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
361 NE FRANKLIN AVE, BEND, OR 97701-4917
(541) 241-8652
Mailing address
900 NE WARNER PL APT 131, BEND, OR 97701-4684
(541) 848-3181
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27730
OR
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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