Provider Demographics
NPI:1215592142
Name:LULAY, MERSADEE JEANNE (LMT)
Entity Type:Individual
Prefix:
First Name:MERSADEE
Middle Name:JEANNE
Last Name:LULAY
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 1:201 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1905
Mailing Address - Country:US
Mailing Address - Phone:503-508-1654
Mailing Address - Fax:
Practice Address - Street 1:612 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1404
Practice Address - Country:US
Practice Address - Phone:503-873-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist