Individual
JESSICA ROSE VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90971 S WILLAMETTE ST, COBURG, OR 97408-9206
(833) 628-5433
Mailing address
1295 RIVER RD, EUGENE, OR 97404-3537
(541) 521-6766
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26072
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26072
—
OR
Enumeration date
01/05/2021
Last updated
01/05/2021
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