Healthcare Provider Details

I. General information

NPI: 1235680018
Provider Name (Legal Business Name): ASHLEY WHITAKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 CITY VIEW ST
EUGENE OR
97405-1529
US

IV. Provider business mailing address

2120 CITY VIEW ST
EUGENE OR
97405-1529
US

V. Phone/Fax

Practice location:
  • Phone: 541-968-2008
  • Fax:
Mailing address:
  • Phone: 541-968-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22726
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: