Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15874 | OR |
NPI | 1003176884 |
---|---|
Provider Name | Sarah Elizabeth Cooper |
First Address | Eugene, OR 97403-2159 |
Second Address | Eugene, OR 97401-4783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 14/08/2012 |