Healthcare Provider Details

I. General information

NPI: 1770215246
Provider Name (Legal Business Name): LAUGHING BIRCH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 15TH AVE. SUITE F
EUGENE OR
97401
US

IV. Provider business mailing address

260 E 15TH AVE. SUITE F
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-914-5883
  • Fax:
Mailing address:
  • Phone: 541-914-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. MIA YVONNE BAKI
Title or Position: OWNER
Credential: LMT
Phone: 541-914-5883