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General NPI Number Information
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NPI Number | 1851851273
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Entity Type | Organization
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Legal Business Name | BAM BEAUTY AND MASSAGE LLC
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 242 NE MAIN ST
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City | WILLAMINA
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State | OR
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Zip | 97396-2784
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Country | US
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Telephone | 971-241-7928
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Fax | 971-275-1314
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Provider Business Mailing Address
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Address Line | PO BOX 329
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City | WILLAMINA
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State | OR
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Zip | 97396-0329
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Country | US
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Telephone | 971-241-7928
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Fax | 971-275-1314
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER VANSCOYK
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Credential |
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Telephone | 971-241-7928
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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 |
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License Number State |
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