Healthcare Provider Details

I. General information

NPI: 1427698042
Provider Name (Legal Business Name): MICHELLE D KREIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 01/11/2020
Certification Date: 01/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ALEXANDER LOOP STE 110
EUGENE OR
97401-6753
US

IV. Provider business mailing address

1285 E ST
SPRINGFIELD OR
97477-4865
US

V. Phone/Fax

Practice location:
  • Phone: 541-423-7009
  • Fax: 541-600-7235
Mailing address:
  • Phone: 541-761-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number25185
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: