Individual
JESSE TRISTAN SLATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AAS
Contact information
Practice address
816 NW HILL ST, BEND, OR 97703-2925
(541) 280-7234
Mailing address
18973 BAKER RD, BEND, OR 97702-7917
(541) 280-7234
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22002
OR
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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