Healthcare Provider Details

I. General information

NPI: 1497950034
Provider Name (Legal Business Name): JENNIFER PUMPELLY MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22595 SW PINE ST
SHERWOOD OR
97140-9408
US

IV. Provider business mailing address

17872 SW DODSON DR
SHERWOOD OR
97140-8239
US

V. Phone/Fax

Practice location:
  • Phone: 971-732-6470
  • Fax:
Mailing address:
  • Phone: 503-625-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12000
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: