Individual
DANIELLE NICOLE LEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMTMI
Contact information
Practice address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
Mailing address
6701 SE 67TH AVE, PORTLAND, OR 97206-7305
(503) 522-3732
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9522
OR
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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