Individual
JOLENE RENEE KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1421 SE ANKENY ST, PORTLAND, OR 97214-1471
(503) 319-9747
Mailing address
134 NE 22ND AVE, PORTLAND, OR 97232-3104
(503) 319-9747
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17693
OR
Other
Enumeration date
01/23/2012
Last updated
05/30/2012
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