Individual
MANORA FAWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
632 ANDERSON AVE, COOS BAY, OR 97420-1632
(541) 267-4439
Mailing address
632 ANDERSON AVE, COOS BAY, OR 97420-1632
(541) 267-4439
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
4636
OR
Other
Enumeration date
01/21/2009
Last updated
01/21/2009
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