Individual
MISS TARA JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
207 FIR ST, LA GRANDE, OR 97850-2626
(541) 624-2000
Mailing address
1110 W AVE, LA GRANDE, OR 97850-2767
(541) 910-8459
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13316
OR
Other
Enumeration date
05/24/2011
Last updated
05/24/2011
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