Individual
MRS. LISA ANN CALLERY KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
3521 MUD PUPPY LN SE, SALEM, OR 97317-9434
(503) 871-7717
Mailing address
3521 MUD PUPPY LN SE, SALEM, OR 97317-9434
(503) 871-7717
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
096007075RN
OR
225700000X
Massage Therapist
Primary
13994
OR
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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