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General NPI Number Information
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NPI Number | 1437276342
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Entity Type | Individual
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Provider Name | QUCHYAL LEI DANCE LMT
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Gender | Female
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 141 SW G ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-2413
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Country | US
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Telephone | 541-479-8621
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Fax | 541-479-8621
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Provider Business Mailing Address
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Address Line | 680 ROBMAR LN
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City | GRANTS PASS
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State | OR
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Zip | 97527-8936
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Country | US
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Telephone | 541-226-7605
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Fax | 541-479-8621
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 3584
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License Number State | OR
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