Individual
KELLY GOODSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2004 MAIN ST STE 204, FOREST GROVE, OR 97116-7339
(503) 577-3765
Mailing address
2529 WILLIAMS ST, FOREST GROVE, OR 97116-3078
(503) 577-3765
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26116
OR
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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