Provider Demographics
NPI:1053688663
Name:HOLMES-FRAHM, NERISSA RAE (LMT)
Entity Type:Individual
Prefix:
First Name:NERISSA
Middle Name:RAE
Last Name:HOLMES-FRAHM
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 1:550 NW 3RD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3546
Mailing Address - Country:US
Mailing Address - Phone:971-227-0930
Mailing Address - Fax:
Practice Address - Street 1:550 NW 3RD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3546
Practice Address - Country:US
Practice Address - Phone:971-227-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist