Healthcare Provider Details

I. General information

NPI: 1376187724
Provider Name (Legal Business Name): VANESSA ANNABELLA RAYE STEELE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 NW HILL ST STE 6
BEND OR
97703-2902
US

IV. Provider business mailing address

61468 ELDER RIDGE ST
BEND OR
97702-1193
US

V. Phone/Fax

Practice location:
  • Phone: 541-420-0644
  • Fax:
Mailing address:
  • Phone: 503-302-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24589
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: