Individual
MIRA BROCKELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
204 S 1ST ST, TALENT, OR 97540-7002
(971) 275-2854
Mailing address
204 S 1ST ST, TALENT, OR 97540-7002
(971) 275-2854
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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