Provider Demographics
NPI:1003154840
Name:CRAVEN, JASMINE R (LMT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:R
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0762
Mailing Address - Country:US
Mailing Address - Phone:503-468-8703
Mailing Address - Fax:
Practice Address - Street 1:1230 MARINE DR STE 305
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4061
Practice Address - Country:US
Practice Address - Phone:503-468-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16697225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist