Provider Demographics
NPI:1083470298
Name:TABER, NICOLE C (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:TABER
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 1:152 NW BREE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-9550
Mailing Address - Country:US
Mailing Address - Phone:541-606-0532
Mailing Address - Fax:
Practice Address - Street 1:146 CHIEF MIWALETA LN
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-9700
Practice Address - Country:US
Practice Address - Phone:541-839-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist