Provider Demographics
NPI:1245407980
Name:FARLEY, LORI CELESTE (MSOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:CELESTE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MSOM, LAC
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 923
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-0923
Mailing Address - Country:US
Mailing Address - Phone:541-430-5393
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH STATE STREET
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479
Practice Address - Country:US
Practice Address - Phone:541-459-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist