Individual
MICHELE HISLOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, QMHA, LMT
Contact information
Practice address
435 NE EVANS ST, MCMINNVILLE, OR 97128-4628
(503) 472-4020
Mailing address
633 NE 8TH ST, MCMINNVILLE, OR 97128-3911
(503) 560-0446
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
225700000X
Massage Therapist
10968
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10968
LISENCED MASSAGE THERAPIS
OR
Enumeration date
06/06/2007
Last updated
09/18/2019
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