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General NPI Number Information
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NPI Number | 1427561182
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Entity Type | Organization
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Legal Business Name | HAVEN STONE MASSAGE
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 1530 E 1ST ST
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City | NEWBERG
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State | OR
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Zip | 97132-3237
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Country | US
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Telephone | 503-430-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 215 W ILLINOIS ST
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City | NEWBERG
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State | OR
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Zip | 97132-1607
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Country | US
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Telephone | 503-430-4200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HILARY VANESSA BRAMLEY
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Credential | LMT
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Telephone | 503-430-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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