Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 5829 | OR |
NPI | 1013102375 |
---|---|
Provider Name | Debra A. Gebhard |
First Address | Wolf Creek, OR 97497-0023 |
Second Address | Grants Pass, OR 97526-2413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |