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General NPI Number Information
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NPI Number | 1114477759
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Entity Type | Organization
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Legal Business Name | BREATHING ROOM MASSAGE
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 1635 4TH ST
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City | BAKER CITY
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State | OR
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Zip | 97814-3856
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Country | US
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Telephone | 541-598-4598
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Fax |
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Provider Business Mailing Address
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Address Line | 61373 FRANKE LN
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City | BEND
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State | OR
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Zip | 97702-9402
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Country | US
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Telephone | 541-598-4598
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/OWNER
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Name | MS. MAUREEN ELAINE QUINN
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Credential | LMT
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Telephone | 541-598-4598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21159
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License Number State | OR
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