Healthcare Provider Details

I. General information

NPI: 1427962752
Provider Name (Legal Business Name): HEATHER ELLEN THILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SW 5TH ST
GRANTS PASS OR
97526-2509
US

IV. Provider business mailing address

333 SW 5TH ST
GRANTS PASS OR
97526-2509
US

V. Phone/Fax

Practice location:
  • Phone: 541-471-0397
  • Fax:
Mailing address:
  • Phone: 541-471-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-22627
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: