Individual
CONNIE L KOCZUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12113 GOLF LN SE, SUBLIMITY, OR 97385-9707
(503) 910-8663
Mailing address
PO BOX 558, SUBLIMITY, OR 97385-0558
(503) 910-8663
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17959
OR
374U00000X
Home Health Aide
795072
OR
Other
Enumeration date
05/04/2011
Last updated
03/25/2016
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