Healthcare Provider Details

I. General information

NPI: 1902305196
Provider Name (Legal Business Name): KERI LYNN GARRISON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NW LOUISIANA AVE
BEND OR
97703-3310
US

IV. Provider business mailing address

61618 SUMMER SHADE DR
BEND OR
97702-2014
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-0334
  • Fax:
Mailing address:
  • Phone: 458-256-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23936
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: