Individual
DEANNA MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT LICENSE #13180
Contact information
Practice address
7817 SE STARK ST, PORTLAND, OR 97215-2339
(503) 956-8984
Mailing address
7817 SE STARK ST, PORTLAND, OR 97215-2339
(503) 956-8984
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13180
OR
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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