Individual
HOLLY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15081 SE 126TH AVE, CLACKAMAS, OR 97015-9257
(503) 419-8337
Mailing address
15081 SE 126TH AVE, CLACKAMAS, OR 97015-9257
(503) 419-8337
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11496
OR
Other
Enumeration date
04/30/2015
Last updated
05/01/2015
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