Individual
NICOLE AGAZARM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
8752 N COLUMBIA BLVD APT 4, PORTLAND, OR 97203-6742
(503) 438-5472
Mailing address
8752 N COLUMBIA BLVD APT 4, PORTLAND, OR 97203-6742
(503) 438-5472
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22872
OR
Other
Enumeration date
12/01/2016
Last updated
12/01/2016
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