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1972975993
MARY DICICCO
WILSONVILLE, OR
NPI
1972975993
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: OR 09213)
Enumeration Date
2015-10-29
Last Update Date
2015-10-29
Business Address
MARY DICICCO
25117 SW PARKWAY AVE
WILSONVILLE, OR 97070-9697
Phone number: 503-570-3665
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Mailing Address
MARY DICICCO
1742 SE MARION ST
PORTLAND, OR 97202-7350
Phone number:
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