=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407098361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER MARIE SEALS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3276 COMMERCIAL SW
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-370-9090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1259 SE JEFFERSON ST
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97338-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-856-6961
-----------------------------------------------------
Fax | 503-370-9090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 15292
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------