Individual
KAITLYN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7817 SE STARK ST, PORTLAND, OR 97215-2339
(503) 975-5298
(503) 546-7496
Mailing address
3246 NE 49TH AVE, PORTLAND, OR 97213-1849
(971) 270-6064
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25073
OR
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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