Individual
MISS CASSANDRA SHELLICE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
317 N MOLALLA AVE, MOLALLA, OR 97038
(503) 829-6176
(503) 829-6178
Mailing address
PO BOX 270, MOLALLA, OR 97038
(503) 829-6176
(503) 829-6178
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16118
OR
Other
Enumeration date
10/30/2017
Last updated
10/31/2017
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