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General NPI Number Information
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NPI Number | 1871383919
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Entity Type | Organization
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Legal Business Name | CURIOUS CROW TATTOO LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 252 SW MADISON AVE STE 120
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City | CORVALLIS
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State | OR
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Zip | 97333-4895
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Country | US
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Telephone | 509-551-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 252 SW MADISON AVE STE 120
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City | CORVALLIS
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State | OR
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Zip | 97333-4895
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Country | US
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Telephone | 509-551-8867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CASSIDY FAULDS
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Credential |
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Telephone | 509-551-8867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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