Individual
CARISSA CAMILE CONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1427 NW FLANDERS SUITE A, PORTLAND, OR 97209
(503) 972-0235
(503) 379-1523
Mailing address
1427 A NW FLANDERS ST, PORTLAND, OR 97209
(503) 972-0235
(503) 379-1523
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7285
OR
Other
Enumeration date
01/21/2011
Last updated
09/25/2012
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