Individual
CAMERON KAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
2935 MARINE DR, ASTORIA, OR 97103-2831
(503) 298-8517
Mailing address
709 EXCHANGE ST, ASTORIA, OR 97103-4625
(503) 298-8517
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12739
OR
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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