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General NPI Number Information
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NPI Number | 1245828201
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Entity Type | Individual
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Provider Name | JESSICA ROSE VAUGHAN
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 90971 S WILLAMETTE ST
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City | COBURG
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State | OR
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Zip | 97408-9206
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Country | US
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Telephone | 833-628-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 1295 RIVER RD
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City | EUGENE
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State | OR
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Zip | 97404-3537
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Country | US
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Telephone | 541-521-6766
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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 | 26072
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License Number State | OR
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