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General NPI Number Information
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NPI Number | 1881477990
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Entity Type | Individual
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Provider Name | CASSANDRA WILSON LMT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 598 NE E ST STE C
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City | GRANTS PASS
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State | OR
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Zip | 97526-2350
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Country | US
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Telephone | 541-761-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 1744 HAMILTON LN
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City | GRANTS PASS
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State | OR
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Zip | 97527-4702
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Country | US
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Telephone | 541-761-0017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 27214
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License Number State | OR
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