Individual
JACLYN R REGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
12750 SW 2ND ST, SUITE 102, BEAVERTON, OR 97005-2778
(971) 336-5134
Mailing address
2212 SE NORDLUND CT, HILLSBORO, OR 97123-6164
(971) 336-5134
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
222313
OR
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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