MEDICARE: VALYNN MOHORICH

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	6336	OR

General Provider Information

NPI Number	:	1215468210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALYNN MOHORICH

Provider Business Mailing Address
First Line	:	PO BOX 201
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-0201
Country	:	US
Telephone Number	:	503-539-4303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 21ST AVE
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1638
Country	:	US
Telephone Number	:	503-539-4303
Fax Number	:

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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Directions to “ VALYNN MOHORICH ” Practice Location

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