Healthcare Provider Details

I. General information

NPI: 1215840541
Provider Name (Legal Business Name): COLLEEN NOEL HEISEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 SW EMKAY DR
BEND OR
97702-3162
US

IV. Provider business mailing address

23 MEADOW HILLS LN
ELMA WA
98541-9495
US

V. Phone/Fax

Practice location:
  • Phone: 541-610-6057
  • Fax:
Mailing address:
  • Phone: 360-701-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29383
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: