Healthcare Provider Details

I. General information

NPI: 1588191647
Provider Name (Legal Business Name): ERICA ENSMINGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33864 SE EASTGATE CIR
CORVALLIS OR
97333-2248
US

IV. Provider business mailing address

29955 FAYETTEVILLE DR
SHEDD OR
97377-9712
US

V. Phone/Fax

Practice location:
  • Phone: 541-961-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21072
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: