Individual
EDWARD WICKWIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
917 SW OAK ST STE 209, PORTLAND, OR 97205-2805
(503) 702-3151
Mailing address
917 SW OAK ST STE 209, PORTLAND, OR 97205-2805
(503) 702-3151
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8033
OR
Other
Enumeration date
10/09/2012
Last updated
10/09/2012
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