Healthcare Provider Details

I. General information

NPI: 1942424312
Provider Name (Legal Business Name): JAIME PHELPS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OREGON STATE UNIVERSITY PLAGMAN HALL
CORVALLIS OR
97331-5801
US

IV. Provider business mailing address

2128 SW BUTTERFIELD DR
CORVALLIS OR
97333-1717
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-7587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6028
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: