Individual
ADELA THEODORA BASAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.M.T.
Contact information
Practice address
116 N PAGE ST, PORTLAND, OR 97227-1909
(503) 975-8713
Mailing address
4940 SW HEWETT BLVD, PORTLAND, OR 97221-2205
(503) 975-8713
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2556
OR
Other
Enumeration date
08/27/2008
Last updated
08/27/2008
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