Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 121066 | TX |
Y | 225700000X | Massage Therapist | 26071 | OR |
NPI | 1013502590 |
---|---|
Provider Name | Mrs. Lauren Elizabeth Sorrells |
First Address | Prineville, OR 97754-1842 |
Second Address | Prineville, OR 97754-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2021 |
Last Update Date | 05/03/2021 |