Individual
FAWNDOVE O BRUBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
12514 SE 7TH ST APT B24, VANCOUVER, WA 98683-4075
(503) 490-4149
Mailing address
19206 SE 1ST ST, STE 118, CAMAS, WA 98607-7478
(503) 490-4149
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60242466
WA
225700000X
Massage Therapist
10892
OR
Other
Enumeration date
05/23/2006
Last updated
09/14/2012
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