MARY DICICCO
Restorative Service Providers at Parkway Ave, Charbonneau, OR

License number
Oregon 09213
Category
Restorative Service Providers
Type
Physical Therapy Assistant
Address
Address 2
25117 SW Parkway Ave, Charbonneau, OR 97070
1742 SE Marion St, Portland, OR 97202
Phone
(503) 570-3665
National Provider ID: 1972975993
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Personal information

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Name
Address
Phone
Mary Dicicco, age 47
1742 SE Marion St, Portland, OR 97202

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