Individual
DIANE R COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
0112 SW HAMILON ST, PORTLAND, OR 97239-4125
(971) 235-9970
Mailing address
0112 SW HAMILTON ST, PORTLAND, OR 97239-4125
(971) 235-9970
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10408
OR
Other
Enumeration date
01/26/2009
Last updated
01/20/2016
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