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General NPI Number Information
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NPI Number | 1467950485
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Entity Type | Individual
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Provider Name | TAWNYA RENEE GROGAN
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 2455 MCGILCHRIST ST SE
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City | SALEM
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State | OR
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Zip | 97302-1116
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Country | US
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Telephone | 503-510-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 2448 DRIFT CREEK RD NE
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City | SILVERTON
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State | OR
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Zip | 97381-9587
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Country | US
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Telephone | 503-510-1522
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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 | 19490
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License Number State | OR
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