Individual
JAE M FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10001 SE SUNNYSIDE RD, STE 220, CLACKAMAS, OR 97015-5746
(503) 908-0881
(503) 908-0891
Mailing address
10001 SE SUNNYSIDE RD, STE 220, CLACKAMAS, OR 97015-5746
(503) 908-0881
(503) 908-0891
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023062
OR
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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