Individual
KENNETH MALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5200 S MACADAM AVE, PORTLAND, OR 97239-6103
(503) 206-0300
Mailing address
4111 SE RAYMOND ST, PORTLAND, OR 97202-4060
(612) 867-6033
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
29062
OR
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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