Individual
CARISSA RUTH CAMPOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
14783 SW 109TH AVE, APT 1, TIGARD, OR 97224-3224
(503) 487-7348
Mailing address
14783 SW 109TH AVE, APT 1, TIGARD, OR 97224-3224
(503) 487-7348
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13603
OR
Other
Enumeration date
07/30/2010
Last updated
07/30/2010
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