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Individual

MICALENE STAFFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
320 N MAIN ST, SUITE 203, PRINEVILLE, OR 97754-1861
(541) 233-8197
Mailing address
320 N MAIN ST, SUITE 203, PRINEVILLE, OR 97754-1861

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6751
OR

Other

Enumeration date
08/31/2016
Last updated
08/31/2016
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