Individual
KIESA RENE CARBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1413 SE HAWTHORNE BLVD, PORTLAND, OR 97214-3640
(503) 841-6060
Mailing address
1550 SE LAVA DR APT 17, MILWAUKIE, OR 97222-3401
(310) 210-2063
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25668
OR
Other
Enumeration date
08/08/2021
Last updated
08/08/2021
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