MEDICARE: MR. BOHANNON FARAON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	27265	OR

General Provider Information

NPI Number	:	1154274199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOHANNON FARAON

Provider Business Mailing Address
First Line	:	156 CHEMAWA RD N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-5356
Country	:	US
Telephone Number	:	503-999-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 CHEMAWA RD N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-5356
Country	:	US
Telephone Number	:	503-999-5960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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Directions to “ MR. BOHANNON FARAON ” Practice Location

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