Individual
KEZIAH JOY CARTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6510 NE SISKIYOU ST, PORTLAND, OR 97213-4572
(503) 290-4757
Mailing address
6334 N DEPAUW ST, PORTLAND, OR 97203-5124
(503) 853-1131
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23490
OR
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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