Provider Demographics
NPI:1003935800
Name:BACHMAN, TANYA ROCHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ROCHELLE
Last Name:BACHMAN
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 1:51682 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-4514
Mailing Address - Country:US
Mailing Address - Phone:503-396-0407
Mailing Address - Fax:
Practice Address - Street 1:51682 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-4514
Practice Address - Country:US
Practice Address - Phone:503-396-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist