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General NPI Number Information
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NPI Number | 1376054320
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Entity Type | Individual
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Provider Name | ALEGRA WOLFF-LYNNE LMT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 2507 MAIN AVE N
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City | TILLAMOOK
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State | OR
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Zip | 97141-9297
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Country | US
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Telephone | 971-350-8599
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Fax |
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Provider Business Mailing Address
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Address Line | 8955 NEHALEM RD
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City | NEHALEM
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State | OR
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Zip | 97131-8400
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Country | US
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Telephone | 503-380-4164
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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 | 023280
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License Number State | OR
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