Individual
ANNA-LIESE AMUNDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
824 E JACKSON ST STE A, MEDFORD, OR 97504-6745
(458) 225-9225
Mailing address
345 LIBERTY ST, ASHLAND, OR 97520-3039
(503) 400-8234
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24474
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BC000R3R
JACKSON CARE
OR
Enumeration date
11/28/2018
Last updated
11/28/2018
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