Individual
JACQUELINE T. FARLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
5616 LAKE SHORE DR, SELMA, OR 97538-9711
(541) 659-9437
(541) 597-4749
Mailing address
PO BOX 714, SELMA, OR 97538-0714
(541) 597-4749
(541) 597-4749
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
7399
OR
Other
Enumeration date
03/04/2008
Last updated
03/04/2008
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