Individual
MR. AUTUMN KAY EMBERSONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
9045 SW BARBUR BLVD STE 109, PORTLAND, OR 97219-4027
(503) 662-8098
Mailing address
9045 SW BARBUR BLVD STE 109, PORTLAND, OR 97219-4027
(503) 662-8098
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26870
OR
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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