Individual
JACOB LYN THOMASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22000 WILLAMETTE DR STE 107, WEST LINN, OR 97068-3210
(503) 722-8888
Mailing address
22000 WILLAMETTE DR STE 107, WEST LINN, OR 97068-3210
(503) 722-8888
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22597
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-3756140
DO NOT ACCEPT
OR
Enumeration date
07/21/2017
Last updated
06/16/2018
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