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General NPI Number Information
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NPI Number | 1447420674
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Entity Type | Individual
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Provider Name | JACQUELINE T. FARLESS L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 5616 LAKE SHORE DR
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City | SELMA
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State | OR
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Zip | 97538-9711
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Country | US
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Telephone | 541-659-9437
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Fax | 541-597-4749
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Provider Business Mailing Address
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Address Line | PO BOX 714
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City | SELMA
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State | OR
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Zip | 97538-0714
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Country | US
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Telephone | 541-597-4749
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Fax | 541-597-4749
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 7399
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License Number State | OR
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