Healthcare Provider Details

I. General information

NPI: 1831444611
Provider Name (Legal Business Name): ROBERT L. NUTTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PORTLAND AVE
MEDFORD OR
97504-7309
US

IV. Provider business mailing address

PO BOX 2303
WHITE CITY OR
97503
US

V. Phone/Fax

Practice location:
  • Phone: 541-660-5714
  • Fax: 541-245-1530
Mailing address:
  • Phone: 541-660-5714
  • Fax: 541-245-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LEWIS NUTTING
Title or Position: BUSINESS OWNER
Credential: MSW, LCSW, LMT
Phone: 541-660-5714