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General NPI Number Information
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NPI Number | 1639371420
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Entity Type | Individual
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Provider Name | PAULETTE R THOMAS LMT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | 1320 EDGEWATER ST NW STE 200
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City | SALEM
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State | OR
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Zip | 97304-4072
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Country | US
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Telephone | 503-871-0062
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Fax |
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Provider Business Mailing Address
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Address Line | 3898 LONE OAK RD SE
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City | SALEM
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State | OR
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Zip | 97302-4743
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Country | US
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Telephone | 503-871-0062
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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 | 12288
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License Number State | OR
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