Individual
MARIA ELIZABETH FORTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
455 S 4TH ST, SUITE #7, COOS BAY, OR 97420-1546
(541) 253-6216
Mailing address
PO BOX 924, BANDON, OR 97411-0924
(541) 253-6216
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16171
OR
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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