Provider Demographics
NPI:1023221579
Name:TAYLOR, GEM MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:GEM
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:GEM
Other - Middle Name:MARIE
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:265 TANGENT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2728
Mailing Address - Country:US
Mailing Address - Phone:541-974-8194
Mailing Address - Fax:541-833-0906
Practice Address - Street 1:265 TANGENT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2728
Practice Address - Country:US
Practice Address - Phone:541-974-8194
Practice Address - Fax:541-833-0906
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015257225700000X
OR15086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0158132OtherDEPT. OF LABOR AND INDUST