Individual
NICOL J DRISCOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7904 SE 13TH AVE, PORTLAND, OR 97202-6667
(503) 282-6552
Mailing address
3706 SE NEHALEM ST, PORTLAND, OR 97202-8036
(503) 282-6552
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10988
STATE LICENSE
OR
Enumeration date
11/14/2007
Last updated
12/22/2021
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