Individual
BRANDI TIFFANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1567 SE TACOMA ST, PORTLAND, OR 97202-6643
(503) 488-0081
Mailing address
8075 SE 8TH AVE, PORTLAND, OR 97202-6565
(503) 488-0081
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14405
OR
Other
Enumeration date
08/30/2008
Last updated
08/30/2008
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