Provider Demographics
NPI:1427406016
Name:ISRAEA, ARIEL ELICIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ARIEL
Middle Name:ELICIA
Last Name:ISRAEA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:ARIEL
Other - Middle Name:ELICIA ISRAEA
Other - Last Name:REDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9575
Mailing Address - Country:US
Mailing Address - Phone:541-531-2261
Mailing Address - Fax:
Practice Address - Street 1:911 CLAY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3669
Practice Address - Country:US
Practice Address - Phone:541-531-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist