Individual
MRS. JANICE CAROLE MODESITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
16463 BOONES FERRY RD, LAKE OSWEGO, OR 97035-4259
(503) 699-2955
Mailing address
4299 SW COUNTRY WOODS COURT, LAKE OSWEGO, OR 97035
(503) 635-6858
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1035
OR
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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