Provider Demographics
NPI:1508163528
Name:BRAY-KIPP, EVA CHRISTINE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:CHRISTINE
Last Name:BRAY-KIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85138 APPLETREE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9702
Mailing Address - Country:US
Mailing Address - Phone:541-521-1798
Mailing Address - Fax:
Practice Address - Street 1:743 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2501
Practice Address - Country:US
Practice Address - Phone:541-343-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist