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General NPI Number Information
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NPI Number | 1982481081
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Entity Type | Individual
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Provider Name | KAMBRY ALISE BERG LMT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 716 SW 11TH ST
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City | REDMOND
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State | OR
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Zip | 97756-2648
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Country | US
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Telephone | 541-852-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 NW 22ND ST
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City | REDMOND
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State | OR
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Zip | 97756-7654
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Country | US
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Telephone | 541-852-6770
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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 | 19393
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License Number State | OR
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