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Individual

AMANDA CAROLL HUELLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
23955 N FORK RD SE, LYONS, OR 97358-9703
(503) 510-6723
Mailing address
23955 N FORK RD SE, LYONS, OR 97358-9703

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7441
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7441
MASSAGE THERAPIST
OR
Enumeration date
02/12/2018
Last updated
02/12/2018
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