Individual
SANDY LYNN HOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC, LMT
Contact information
Practice address
905 SE ANKENY ST, PORTLAND, OR 97214-1349
(503) 516-6425
Mailing address
905 SE ANKENY ST, PORTLAND, OR 97214-1349
(503) 516-6425
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
179610
OR
225700000X
Massage Therapist
15549
OR
Other
Enumeration date
03/04/2009
Last updated
02/02/2017
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