Provider Demographics
NPI:1437453198
Name:MORALLI, ROBIN LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:MORALLI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9045
Mailing Address - Country:US
Mailing Address - Phone:503-764-6190
Mailing Address - Fax:
Practice Address - Street 1:616 HEMLOCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9456
Practice Address - Country:US
Practice Address - Phone:541-813-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist