Provider Demographics
NPI:1134471303
Name:BECKER, JANENE K (LMT, CA)
Entity Type:Individual
Prefix:MS
First Name:JANENE
Middle Name:K
Last Name:BECKER
Suffix:
Gender:F
Credentials:LMT, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4604
Mailing Address - Country:US
Mailing Address - Phone:541-510-0142
Mailing Address - Fax:
Practice Address - Street 1:4750 W HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4604
Practice Address - Country:US
Practice Address - Phone:541-510-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5222OtherLMT LICENSE