Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 26076 | OR |
NPI | 1013685866 |
---|---|
Provider Name | Erika Hageman |
First Address | Grants Pass, OR 97527-7208 |
Second Address | Grants Pass, OR 97526-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2021 |
Last Update Date | 04/09/2021 |