Individual
MISS ELISA JANE MATTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S., L.M.T.
Contact information
Practice address
32598 PITTSBURG RD, SAINT HELENS, OR 97051-9124
(503) 438-8017
Mailing address
6615 SE 58TH AVE, PORTLAND, OR 97206-7513
(503) 438-8017
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11684
OR
Other
Enumeration date
10/13/2010
Last updated
10/13/2010
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