Healthcare Provider Details

I. General information

NPI: 1912571985
Provider Name (Legal Business Name): LENEA RACHELLE PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SHELTON MCMURPHEY BLVD STE 300
EUGENE OR
97401-8718
US

IV. Provider business mailing address

120 SHELTON MCMURPHEY BLVD STE 300
EUGENE OR
97401-8718
US

V. Phone/Fax

Practice location:
  • Phone: 458-210-2940
  • Fax: 877-796-0176
Mailing address:
  • Phone: 458-210-2940
  • Fax: 877-796-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26289
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: