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General NPI Number Information
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NPI Number | 1255732822
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Entity Type | Individual
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Provider Name | NATASHA LIEDKIE LMT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 2515 CROSBY AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-4553
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Country | US
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Telephone | 503-798-5690
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Fax | 541-273-6279
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Provider Business Mailing Address
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Address Line | 2515 CROSBY AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-4553
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Country | US
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Telephone | 503-798-5690
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Fax | 541-273-6279
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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 | 19074
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License Number State | OR
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