Individual
CHANDRA MAYA IMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6909 SE WOODSTOCK BLVD, PORTLAND, OR 97206-5938
(206) 854-4126
Mailing address
6909 SE WOODSTOCK BLVD, PORTLAND, OR 97206-5938
(206) 854-4126
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19145
OR
Other
Enumeration date
03/10/2016
Last updated
03/10/2016
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