Individual
LACIE KAY MALVANEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
805 SW INDUSTRIAL WAY STE 8, BEND, OR 97702-1093
(541) 610-6057
Mailing address
17317 GOLDEN EYE DR, BEND, OR 97707-2314
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24945
OR
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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