Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 12273 | OR |
NPI | 1003935800 |
---|---|
Provider Name | Tanya Rochelle Bachman |
First Address | Scappoose, OR 97056-4514 |
Second Address | Scappoose, OR 97056-4514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |