Individual
JESSIE P EASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7052 SW NYBERG ST, TUALATIN, OR 97062-9231
(503) 691-7788
Mailing address
PO BOX 1543, TUALATIN, OR 97062-1543
(503) 691-7788
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17229
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17229
STATE OF OREGON, BOARD OF MASSAGE THERAPISTS
OR
Enumeration date
01/28/2013
Last updated
01/28/2013
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