Individual
ANDREA THEA NICODEMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT 25036
Contact information
Practice address
1200 EXECUTIVE PKWY STE 230, EUGENE, OR 97401-2365
(541) 232-2275
Mailing address
2061 DOGWOOD DR, EUGENE, OR 97405-5848
(541) 606-1902
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25036
OR
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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