Individual
MRS. KELLY FAYE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
707 E 5TH ST, MCMINNVILLE, OR 97128-4508
(503) 484-8538
Mailing address
14805 SE FOSTER RD, DAYTON, OR 97114-7426
(503) 484-8538
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15441
OR
Other
Enumeration date
09/14/2009
Last updated
09/14/2009
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