Individual
KATHARINE LEILANI SUPPAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
21440 SW WILDFLOWER DR, NEWBERG, OR 97132-9401
(971) 533-3508
Mailing address
21440 SW WILDFLOWER DR, NEWBERG, OR 97132-9401
(971) 533-3508
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16815
OR
Other
Enumeration date
07/05/2014
Last updated
07/05/2014
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