Healthcare Provider Details

I. General information

NPI: 1245818715
Provider Name (Legal Business Name): MARTHA RENEE SEGARS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 NW IRVING AVE
BEND OR
97703-2012
US

IV. Provider business mailing address

26 NW IRVING AVE
BEND OR
97703-2012
US

V. Phone/Fax

Practice location:
  • Phone: 512-636-7906
  • Fax:
Mailing address:
  • Phone: 512-636-7906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28956
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: