Provider Demographics
NPI:1508147380
Name:SKOMERZA, KIMBERLY A (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SKOMERZA
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 1:945 DAHLIA TER
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-3402
Mailing Address - Country:US
Mailing Address - Phone:541-621-2091
Mailing Address - Fax:
Practice Address - Street 1:945 DAHLIA TER
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-3402
Practice Address - Country:US
Practice Address - Phone:541-621-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18342225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist