Healthcare Provider Details

I. General information

NPI: 1881810026
Provider Name (Legal Business Name): JOANNE MARIE HASTINGS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OREGON STATE UNIVERSITY 201 PLAGEMAN BUILDING
CORVALLIS OR
97331-5801
US

IV. Provider business mailing address

727 NW 12TH ST
CORVALLIS OR
97330-5936
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-9355
  • Fax:
Mailing address:
  • Phone: 541-758-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6973
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: