Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15865 | OR |
NPI | 1013227990 |
---|---|
Provider Name | Lacey Reiss |
First Address | Springfield, OR 97477-4251 |
Second Address | Springfield, OR 97477-4251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 18/01/2022 |