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Individual

MARY ROSE LICARI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2149 NE BROADWAY ST, PORTLAND, OR 97232-1580
(503) 281-0278
Mailing address
2714 SE 138TH AVE APT 55, PORTLAND, OR 97236-2879

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25550
OR

Other

Enumeration date
01/13/2025
Last updated
01/13/2025
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