Individual
KATIE ANNE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 CRATER LAKE AVE STE 113, MEDFORD, OR 97504-6581
(541) 770-1606
Mailing address
3794 WINDGATE ST, MEDFORD, OR 97504-9163
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24569
OR
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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