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General NPI Number Information
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NPI Number | 1376103952
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Entity Type | Individual
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Provider Name | GINA RAE MERRITT LMT
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 108 E HERSEY ST # 2A
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City | ASHLAND
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State | OR
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Zip | 97520-1363
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Country | US
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Telephone | 760-715-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 220 4TH ST APT 4
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City | ASHLAND
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State | OR
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Zip | 97520-2049
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Country | US
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Telephone | 760-715-4977
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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 | 21587
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License Number State | OR
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