Healthcare Provider Details

I. General information

NPI: 1730491093
Provider Name (Legal Business Name): HEATHER RENAE GARRISON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SE 223RD AVE STE 106
GRESHAM OR
97030-7454
US

IV. Provider business mailing address

206 NE OAK VIEW LN
ESTACADA OR
97023-9360
US

V. Phone/Fax

Practice location:
  • Phone: 503-806-6834
  • Fax:
Mailing address:
  • Phone: 503-806-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17414
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: