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General NPI Number Information
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NPI Number | 1992056857
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Entity Type | Individual
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Provider Name | BETH W. MANTIS LMT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 29544 SE HEIPLE RD
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City | EAGLE CREEK
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State | OR
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Zip | 97022-9664
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Country | US
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Telephone | 503-887-6070
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Fax | 503-630-2860
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Provider Business Mailing Address
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Address Line | 29544 SE HEIPLE RD
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City | EAGLE CREEK
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State | OR
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Zip | 97022-9664
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Country | US
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Telephone | 503-887-6070
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Fax | 503-630-2860
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 18018
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License Number State | OR
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