Individual
JESSIE DETTWILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6510 NE SISKIYOU ST, PORTLAND, OR 97213-4572
(503) 290-4757
Mailing address
5722 NE 30TH AVE, PORTLAND, OR 97211-6810
(970) 846-3277
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25499
OR
Other
Enumeration date
01/16/2020
Last updated
01/16/2020
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