Jennifer Marie Boom, LMT
Massage Therapist in Gresham, OR. Individual provider (NPI-1).
NPI number1164547634
StatusActive
Last updated in NPPESNov 9, 2016
Details
- NPI
- 1164547634
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Marie Boom
- Credential
- LMT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 21, 2007
- Last updated
- Nov 9, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 7615 | OR | Yes |
Practice location
24850 Se Stark StSuite 200
Gresham, OR 97030-8316
Phone 503-310-2622
Mailing address
24850 Se Stark StSuite 200
Gresham, OR 97030-8316
Phone 503-310-2622
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