Individual
MAYA GILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
12555 SW 1ST ST, BEAVERTON, OR 97005
(503) 619-6936
Mailing address
12555 SW FIRST ST, BEAVERTON, OR 97005
(503) 619-6936
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14240
OR
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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