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General NPI Number Information
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NPI Number | 1982118956
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Entity Type | Organization
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Legal Business Name | KIRSTEN OPIE THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 19724 NUGGET AVE
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City | BEND
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State | OR
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Zip | 97702-9703
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Country | US
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Telephone | 541-815-4346
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Fax |
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Provider Business Mailing Address
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Address Line | 19724 NUGGET AVE
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City | BEND
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State | OR
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Zip | 97702-9703
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Country | US
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Telephone | 541-815-4346
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN OPIE
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Credential |
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Telephone | 541-815-4346
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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 | 21115
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License Number State | OR
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