Healthcare Provider Details

I. General information

NPI: 1508147380
Provider Name (Legal Business Name): KIMBERLY A SKOMERZA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 DAHLIA TER
EAGLE POINT OR
97524-3402
US

IV. Provider business mailing address

945 DAHLIA TER
EAGLE POINT OR
97524-3402
US

V. Phone/Fax

Practice location:
  • Phone: 541-621-2091
  • Fax:
Mailing address:
  • Phone: 541-621-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18342
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: