Individual
PAKSUPIM COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
618 N MAIN, MILTON FREEWATER, OR 97862
(541) 861-1066
Mailing address
85452 HWY 11, MILTON FREEWATER, OR 97862
(541) 861-1066
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24157
OR
Other
Enumeration date
12/05/2018
Last updated
05/10/2022
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