Individual
JESSICA SPYDER CARNEOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3432 SE GRANT ST, PORTLAND, OR 97214-5732
(608) 516-2142
Mailing address
3432 SE GRANT ST, PORTLAND, OR 97214-5732
(608) 516-2142
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19774
OR
Other
Enumeration date
02/01/2014
Last updated
11/13/2015
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