Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20856 | OR |
NPI | 1003461161 |
---|---|
Provider Name | Sarah Marie Puar |
First Address | Eugene, OR 97402-5165 |
Second Address | Eugene, OR 97402-5165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2019 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20856 | OREGON STATE BOARD OF MASSAGE (01) | OR |