Healthcare Provider Details

I. General information

NPI: 1154695310
Provider Name (Legal Business Name): SERVIAM WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18005 SW FITCH DR
SHERWOOD OR
97140-8860
US

IV. Provider business mailing address

18005 SW FITCH DR
SHERWOOD OR
97140-8860
US

V. Phone/Fax

Practice location:
  • Phone: 503-925-9237
  • Fax:
Mailing address:
  • Phone: 503-925-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number225700000X
License Number StateOR

VIII. Authorized Official

Name: RICK SNOOK
Title or Position: PRESEDENT
Credential:
Phone: 503-313-9245