Individual
BROOKS AUTUMN GEORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3 MONROE PKWY STE U, LAKE OSWEGO, OR 97035-8875
(503) 387-3205
(503) 336-1001
Mailing address
19250 VIEW DR, WEST LINN, OR 97068-1335
(435) 531-8681
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25365
OR
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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