Jesse Tristan Slater, AAS
Massage Therapist in Bend, OR. Individual provider (NPI-1).
NPI number1669919981
StatusActive
Last updated in NPPESJan 24, 2017
Details
- NPI
- 1669919981
- Entity type
- Individual (NPI-1)
- Name
- Jesse Tristan Slater
- Credential
- AAS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 24, 2017
- Last updated
- Jan 24, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 22002 | OR | Yes |
Practice location
816 Nw Hill StBend, OR 97703-2925
Phone 541-280-7234
Mailing address
18973 Baker RdBend, OR 97702-7917
Phone 541-280-7234
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