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General NPI Number Information
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NPI Number | 1295098937
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Entity Type | Individual
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Provider Name | JEZELLE MARGO GEBER
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 2728 NE HIGHWAY 101 SUITE 1
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City | LINCOLN CITY
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State | OR
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Zip | 97367-4412
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Country | US
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Telephone | 541-994-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 950 SE 32ND ST APT 14
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City | LINCOLN CITY
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State | OR
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Zip | 97367-1803
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Country | US
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Telephone | 503-888-2234
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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 | 18091
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License Number State | OR
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