Individual
MISS BRANDI REID MACKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
9645 NE MASON ST, PORTLAND, OR 97220-3504
(503) 781-4246
Mailing address
9645 NE MASON ST, PORTLAND, OR 97220-3504
(503) 781-4246
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13132
OR
Other
Enumeration date
04/27/2010
Last updated
04/27/2010
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