Individual
AUDREY JANE WIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
Mailing address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023192
OR
Other
Enumeration date
04/25/2017
Last updated
04/25/2017
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