Individual
AMANDA K VAN PELT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 NE KELLY AVE, GRESHAM, OR 97030-7455
(971) 678-3178
Mailing address
307 NE KELLY AVE, GRESHAM, OR 97030-7455
(971) 678-3178
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
61298
OR
Other
Enumeration date
02/24/2023
Last updated
02/24/2023
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