Individual
KAYLA JADE KAWECKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
258 A STREET, SUITE 21, TALENT, OR 97540
(541) 301-7040
Mailing address
9629 WAGNER CREEK RD, TALENT, OR 97540-7802
(541) 930-0882
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22110
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1363556
AMERICAN MASSAGE THERAPY ASSOCIATION
OR
Enumeration date
07/03/2018
Last updated
07/03/2018
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