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General NPI Number Information
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NPI Number | 1083933782
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Entity Type | Organization
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Legal Business Name | HANDS OF GOLD, LLC
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 3886 TAMARACK LN
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1845
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Country | US
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Telephone | 503-636-8200
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Fax | 503-636-8200
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Provider Business Mailing Address
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Address Line | PO BOX 276
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-0032
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Country | US
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Telephone | 503-636-8200
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Fax | 503-636-8200
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER CASEY
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Credential |
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Telephone | 503-636-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8183
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License Number State | OR
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