Provider Demographics
NPI:1114477759
Name:BREATHING ROOM MASSAGE
Entity Type:Organization
Organization Name:BREATHING ROOM MASSAGE
Other - Org Name:MAUREEN E QUINN, LMT
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-598-4598
Mailing Address - Street 1:61373 FRANKE LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9402
Mailing Address - Country:US
Mailing Address - Phone:541-598-4598
Mailing Address - Fax:
Practice Address - Street 1:1635 4TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3856
Practice Address - Country:US
Practice Address - Phone:541-598-4598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR21159OtherOREGON STATE MASSAGE LICENSE