Healthcare Provider Details

I. General information

NPI: 1275869554
Provider Name (Legal Business Name): ERIN P. MCCABE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 NW 4TH ST
CORVALLIS OR
97330-6409
US

IV. Provider business mailing address

3945 SW COUNTRY CLUB DR
CORVALLIS OR
97333-1458
US

V. Phone/Fax

Practice location:
  • Phone: 541-740-9680
  • Fax:
Mailing address:
  • Phone: 541-230-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16206
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: