Provider Demographics
NPI:1003240045
Name:FIELDS, CORA NADINE (LMT)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:NADINE
Last Name:FIELDS
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 1:401 MADRONA AVE SE
Mailing Address - Street 2:#6
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4654
Mailing Address - Country:US
Mailing Address - Phone:503-999-4463
Mailing Address - Fax:
Practice Address - Street 1:651 HIGH ST NE
Practice Address - Street 2:SUITE #9
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2422
Practice Address - Country:US
Practice Address - Phone:503-999-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19871172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist