Individual
CAROL TEWALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16410 HIGHWAY 126, SISTERS, OR 97759-9599
(971) 302-5479
Mailing address
16410 HIGHWAY 126, SISTERS, OR 97759-9599
(971) 302-5479
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16516
OR
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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