Healthcare Provider Details

I. General information

NPI: 1578757779
Provider Name (Legal Business Name): MARGI D PRINGLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6395 KEIZER STATION BLVD NE SUITE #103
KEIZER OR
97303-2305
US

IV. Provider business mailing address

3807 WILLAMETTE AVE SE APT. D
ALBANY OR
97322-6553
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-1597
  • Fax:
Mailing address:
  • Phone: 503-409-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13022
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: