Healthcare Provider Details

I. General information

NPI: 1386156909
Provider Name (Legal Business Name): GENEVIEVE DAUGHERTY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 PLYMOUTH DR NE STE 101
KEIZER OR
97303-5049
US

IV. Provider business mailing address

1916 MEADOWLARK DR NE
KEIZER OR
97303-1955
US

V. Phone/Fax

Practice location:
  • Phone: 971-217-8370
  • Fax:
Mailing address:
  • Phone: 971-217-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: