Mira Brockelman

NPI #1962048579 in Talent, Oregon

Provider Information

NPI Number: 1962048579
Entity Type: Individual
Name: Mira Brockelman
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Enumeration Date: Nov 19, 2019
Last Updated: Nov 19, 2019

Practice Location

Address: 204 S 1ST ST
City: Talent
State: Oregon
ZIP Code: 97540-7002
Phone: (971) 275-2854

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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