Healthcare Provider Details

I. General information

NPI: 1174354369
Provider Name (Legal Business Name): JEFFREY ABBOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 NW ARIZONA AVE
BEND OR
97703-3260
US

IV. Provider business mailing address

634 NW ARIZONA AVE
BEND OR
97703-3260
US

V. Phone/Fax

Practice location:
  • Phone: 541-797-6744
  • Fax:
Mailing address:
  • Phone: 541-797-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28461
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: