Mira Brockelman
Individual provider Active NPI Massage Therapist · Talent, OR
NPI 1962048579 · NPPES record last updated Nov 19, 2019
Key facts
- NPI
- 1962048579
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- Practice address
- 204 S 1St St
Talent, OR 97540-7002 - Phone
- (971) 275-2854
- NPI assigned
- Nov 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | Yes |
Addresses
Primary practice location
204 S 1St St
Talent, OR 97540-7002
Mailing address
204 S 1St St
Talent, OR 97540-7002
Phone (971) 275-2854
Other providers in Talent, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.