Provider Demographics
NPI:1588039721
Name:REED, ROCHELLE DAWN (LMT)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:DAWN
Last Name:REED
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 1:833 NW BUCHANAN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6217
Mailing Address - Country:US
Mailing Address - Phone:541-731-4535
Mailing Address - Fax:
Practice Address - Street 1:833 NW BUCHANAN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6217
Practice Address - Country:US
Practice Address - Phone:541-731-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19009171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor