Individual
KAILA AUTREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3 MONROE PKWY, SUITE U, LAKE OSWEGO, OR 97035-1486
(503) 387-3205
Mailing address
604 S PONDEROSA ST, CANBY, OR 97013-6312
(541) 815-8863
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22004
OR
Other
Enumeration date
11/23/2016
Last updated
11/23/2016
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