Healthcare Provider Details

I. General information

NPI: 1639887722
Provider Name (Legal Business Name): CATHERINE L FLEMING LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NW 4TH ST
SUBLIMITY OR
97385-9712
US

IV. Provider business mailing address

430 NW 4TH ST
SUBLIMITY OR
97385-9712
US

V. Phone/Fax

Practice location:
  • Phone: 503-910-4251
  • Fax:
Mailing address:
  • Phone: 503-910-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11309
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: