Provider Demographics
NPI:1467677146
Name:BROOKS-VERSCHINGEL, MARY ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BROOKS-VERSCHINGEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:VERSCHINGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:18205 S GRASLE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7872
Mailing Address - Country:US
Mailing Address - Phone:503-631-4481
Mailing Address - Fax:503-631-4482
Practice Address - Street 1:11385 SW SCHOLLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7167
Practice Address - Country:US
Practice Address - Phone:503-524-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5164171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5164OtherMASSAGE THERAPIST