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NPI Code Detail

MEDICARE: JENNIFER ELYSE DOAN LMT

MEDICARE: JENNIFER ELYSE DOAN LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist18602OR

General Provider Information

NPI Number : 1568734663
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ELYSE DOAN LMT
Provider Business Mailing Address
First Line : 3565 DALLAS HWY NW
Second Line :
City : SALEM
State : OR
Zip : 97304-4102
Country : US
Telephone Number : 503-580-6542
Fax Number :
Provider Business Practice Location Address
First Line : 960 LIBERTY ST SE STE 170
Second Line :
City : SALEM
State : OR
Zip : 97302-4149
Country : US
Telephone Number : 503-588-6633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2012
Last Update Date : 02/03/2012

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Directions to “ JENNIFER ELYSE DOAN LMT” Practice Location

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