Provider Demographics
NPI:1265462022
Name:LINDLEY OAKES, JEAN ELIZABETH (RPT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ELIZABETH
Last Name:LINDLEY OAKES
Suffix:
Gender:F
Credentials:RPT
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 1047
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1047
Mailing Address - Country:US
Mailing Address - Phone:541-889-8336
Mailing Address - Fax:541-889-2310
Practice Address - Street 1:514 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3403
Practice Address - Country:US
Practice Address - Phone:541-889-8336
Practice Address - Fax:541-889-2310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-607225100000X
OR1266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117929Medicaid