Individual
DUSTY HOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
557 NW MONROE AVE, CORVALLIS, OR 97330-4721
(541) 766-3540
Mailing address
32554 BELLINGER SCALE RD, LEBANON, OR 97355-9412
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/02/2011
Last updated
01/13/2012
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