Provider Demographics
NPI:1558784215
Name:THIBEDEAU, GINGER JEAN (LMT, MMP, #13728 ORE)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:JEAN
Last Name:THIBEDEAU
Suffix:
Gender:F
Credentials:LMT, MMP, #13728 ORE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 NW STEWART PARKWAY,
Mailing Address - Street 2:SUITE 304 #183
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-733-3398
Mailing Address - Fax:
Practice Address - Street 1:3019 NW STEWART PARKWAY,
Practice Address - Street 2:SUITE 304 #183
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-733-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist