Individual
LACI N COCHRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4230 NE FREMONT ST, PORTLAND, OR 97213-1150
(503) 208-5532
Mailing address
5526 SE 60TH AVE, PORTLAND, OR 97206-5517
(425) 354-0605
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26060
OR
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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