Active NPI
Manora Fawn, L.M.T.
- Mechanotherapist
- Coos Bay, OR
National Provider Identifier
1467690925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 4636
- Practice address
- 632 Anderson Ave
Coos Bay, OR 97420-1632 - Phone
- (541) 267-4439
- NPI assigned
- Jan 21, 2009
- Last updated
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 4636 | OR | Primary |
Addresses
Primary practice location
632 Anderson Ave
Coos Bay, OR 97420-1632
Mailing address
632 Anderson Ave
Coos Bay, OR 97420-1632
Phone (541) 267-4439
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1467690925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 ANDERSON AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974201632",
"telephone_number": "541-267-4439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 ANDERSON AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974201632",
"telephone_number": "541-267-4439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWN",
"first_name": "MANORA",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-21",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "OR",
"license": "4636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.