Healthcare Provider Details

I. General information

NPI: 1710412911
Provider Name (Legal Business Name): KIRSTEN OPIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61396 S HWY 97 STE 203
BEND OR
97702-2159
US

IV. Provider business mailing address

19724 NUGGET AVE
BEND OR
97702-9703
US

V. Phone/Fax

Practice location:
  • Phone: 541-815-4346
  • Fax:
Mailing address:
  • Phone: 541-815-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21115
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: