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General NPI Number Information
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NPI Number | 1154769032
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Entity Type | Individual
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Provider Name | TRINA EDMONDS
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Gender | Female
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 100 KING ST S LIBERTY RD
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City | SALEM
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State | OR
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Zip | 97302-4520
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Country | US
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Telephone | 503-779-8312
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Fax |
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Provider Business Mailing Address
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Address Line | 673 PAGE ST NE
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City | SALEM
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State | OR
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Zip | 97301-5097
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Country | US
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Telephone | 503-779-8312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 16216
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License Number State | OR
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