Individual
GABRIELLE PULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GCFP, LMT
Contact information
Practice address
235 W MAIN ST, JACKSONVILLE, OR 97530-9278
(541) 777-0124
Mailing address
P.O. BOX 7311, JACKSONVILLE, OR 97530-2854
(541) 777-0124
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
174400000X
Specialist
—
—
225400000X
Rehabilitation Practitioner
—
—
225700000X
Massage Therapist
Primary
25754
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25754
OREGON STATE BOARD OF MASSAGE THERAPY LICENSE NUMBER
OR
Enumeration date
05/29/2007
Last updated
02/23/2022
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