Individual
ILONA D KSIAZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
132 W MAIN ST, MEDFORD, OR 97501-2746
(541) 772-2633
Mailing address
1040 BRANDI WAY, CENTRAL POINT, OR 97502-2923
(815) 531-4495
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21964
OR
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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