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General NPI Number Information
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NPI Number | 1720359706
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Entity Type | Individual
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Provider Name | NICOLE MARIE BIDDLECOME LMT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 960 LIBERTY ST SE STE 170
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City | SALEM
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State | OR
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Zip | 97302-4149
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Country | US
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Telephone | 503-588-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 FALCON LOOP
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City | INDEPENDENCE
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State | OR
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Zip | 97351-1538
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Country | US
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Telephone | 503-888-5246
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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 | 18572
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License Number State | OR
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