Provider Demographics
NPI:1518081470
Name:DAVIS, DIANNE E (LMT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:DAVIS
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 1:1907 GARDEN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1934
Mailing Address - Country:US
Mailing Address - Phone:541-344-1906
Mailing Address - Fax:
Practice Address - Street 1:1907 GARDEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1934
Practice Address - Country:US
Practice Address - Phone:541-344-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist