Provider Demographics
NPI:1033364633
Name:ATTEBERY, CORRINE DAWN (LMT, MMP)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:DAWN
Last Name:ATTEBERY
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:DAWN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1473
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-621-4777
Mailing Address - Fax:
Practice Address - Street 1:1056 BEALL LN.
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-621-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13882225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist