Healthcare Provider Details

I. General information

NPI: 1689118564
Provider Name (Legal Business Name): VICTORIAH ANNE HILT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 WALLACE RD NW 150
SALEM OR
97304-2684
US

IV. Provider business mailing address

1572 WALLACE RD NW 150
SALEM OR
97304-2684
US

V. Phone/Fax

Practice location:
  • Phone: 503-798-8406
  • Fax:
Mailing address:
  • Phone: 503-798-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21653
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: