Provider Demographics
NPI:1538468996
Name:EARTHLY OASIS
Entity Type:Organization
Organization Name:EARTHLY OASIS
Other - Org Name:MEDICINE RIVER CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-212-9956
Mailing Address - Street 1:12202 PACIFIC AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5157
Mailing Address - Country:US
Mailing Address - Phone:253-212-9956
Mailing Address - Fax:
Practice Address - Street 1:12202 PACIFIC AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5157
Practice Address - Country:US
Practice Address - Phone:253-212-9956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60077010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty