Provider Demographics
NPI:1215219696
Name:BOYD, MARIJANE MCHENRY (LMT)
Entity Type:Individual
Prefix:
First Name:MARIJANE
Middle Name:MCHENRY
Last Name:BOYD
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 1:141 SW 15TH ST UNIT 42
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1028
Mailing Address - Country:US
Mailing Address - Phone:541-647-7331
Mailing Address - Fax:
Practice Address - Street 1:347 NE KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4551
Practice Address - Country:US
Practice Address - Phone:541-647-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist