Provider Demographics
NPI:1225506157
Name:MEISNER, REANNA MARIE
Entity Type:Individual
Prefix:
First Name:REANNA
Middle Name:MARIE
Last Name:MEISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:DAYS CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97429-0193
Mailing Address - Country:US
Mailing Address - Phone:541-733-1986
Mailing Address - Fax:
Practice Address - Street 1:134 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-9659
Practice Address - Country:US
Practice Address - Phone:541-839-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist