Healthcare Provider Details

I. General information

NPI: 1871042945
Provider Name (Legal Business Name): REBECCA O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEKAH O'BRIEN LMT

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 NE REVERE AVE
BEND OR
97701-4082
US

IV. Provider business mailing address

158 SE HEYBURN ST
BEND OR
97702-1312
US

V. Phone/Fax

Practice location:
  • Phone: 458-206-0757
  • Fax:
Mailing address:
  • Phone: 541-508-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22403
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: