Individual
MRS. FIONA GRACE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
10230 SW HALL BLVD, PORTLAND, OR 97223-5804
(503) 806-4591
Mailing address
11705 NW VALLEVUE CT, PORTLAND, OR 97229-5076
(503) 641-8002
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19740
OR
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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