Healthcare Provider Details

I. General information

NPI: 1609451459
Provider Name (Legal Business Name): REBECCA HUTCHINSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CRATER LAKE AVE STE 113
MEDFORD OR
97504-6581
US

IV. Provider business mailing address

1701 SERENITY DR
MEDFORD OR
97504-5349
US

V. Phone/Fax

Practice location:
  • Phone: 541-770-1606
  • Fax:
Mailing address:
  • Phone: 541-499-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26190
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: