Individual
LAURIE ANN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
21860 WILLAMETTE DR, WEST LINN, OR 97068-3256
(503) 650-0696
Mailing address
2310 SE 147TH AVE, PORTLAND, OR 97233-2723
(503) 762-2230
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11522
OR
Other
Enumeration date
09/14/2010
Last updated
09/14/2010
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