Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 17438 | OR |
NPI | 1003117029 |
---|---|
Provider Name | Denese Lynn Lingle |
First Address | Sublimity, OR 97385-0379 |
Second Address | Stayton, OR 97383-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2010 |
Last Update Date | 15/11/2010 |