Healthcare Provider Details

I. General information

NPI: 1437453198
Provider Name (Legal Business Name): ROBIN LYNN MORALLI L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 HEMLOCK ST SUITE B
BROOKINGS OR
97415-9456
US

IV. Provider business mailing address

422 PINE ST
BROOKINGS OR
97415-9045
US

V. Phone/Fax

Practice location:
  • Phone: 541-813-1863
  • Fax:
Mailing address:
  • Phone: 503-764-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17782
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: