Organization
DANIELLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE SUTTON (LMT)
(509) 760-9947
Entity
Organization
Contact information
Practice address
22400 SE STARK ST, GRESHAM, OR 97030-2656
(509) 760-9947
Mailing address
22400 SE STARK ST, GRESHAM, OR 97030-2656
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19777
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19777
OREGON BOARD OF MASSAGE THERAPISTS
OR
Enumeration date
07/07/2016
Last updated
07/07/2016
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