Individual
GINA MARCELLE LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
62968 O B RILEY RD BLDG E2, BEND, OR 97701-9442
(541) 815-5227
Mailing address
62968 O B RILEY RD BLDG E2, BEND, OR 97701-9442
(541) 815-5227
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10480
OR
Other
Enumeration date
05/05/2007
Last updated
07/08/2007
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