Provider Demographics
NPI:1346011897
Name:GRAHAM, ANNE MC GUIRE (MT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MC GUIRE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540
Mailing Address - Country:US
Mailing Address - Phone:541-210-5999
Mailing Address - Fax:541-210-8725
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540
Practice Address - Country:US
Practice Address - Phone:541-210-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist