Individual
MRS. NICOLE LYNNE DE PICCIOTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2936 SE TIBBETTS ST, PORTLAND, OR 97202-2047
(503) 810-5367
Mailing address
2936 SE TIBBETTS ST, PORTLAND, OR 97202-2047
(503) 810-5367
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19221
OR
Other
Enumeration date
01/17/2013
Last updated
01/17/2013
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