Individual
NICOLE MARIE DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
842 2ND AVE, VERNONIA, OR 97064-1008
(971) 409-8443
Mailing address
842 2ND AVE, VERNONIA, OR 97064-1008
(971) 409-8443
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16099
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16099
OREGON BOARD OF MASSAGE
OR
Enumeration date
09/04/2013
Last updated
09/04/2013
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