Individual
AI WATANABE-DEVORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
987 SISKIYOU BLVD, ASHLAND, OR 97520-2237
(541) 227-1710
Mailing address
2385 MORADA LN, ASHLAND, OR 97520-3640
(541) 227-1710
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20030
OR
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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