Provider Demographics
NPI:1225568561
Name:BURROUGHS, HANNAH LOUISE (LMT)
Entity Type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:LOUISE
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:LOUISE
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1508 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-280-6461
Mailing Address - Fax:
Practice Address - Street 1:1508 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-280-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14577225700000X
14577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist