Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16722 | OR |
N | 226300000X | Kinesiotherapist | 16722 | OR |
NPI | 1245536465 |
---|---|
Provider Name | Susie Burns |
First Address | Bend, OR 97701-4059 |
Second Address | Bend, OR 97701-4059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 13/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16722 | OREGON BOARD OF MASSAGE THERAPISTS (01) | OR |
836868 | ASSOCIATED BODYWORK & MASSAGE PEOFESSIONALS (01) | OR |