Provider Demographics
NPI:1588198675
Name:SKALLA, JANELLE (LMT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:SKALLA
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 1:1904 FUTURE DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2893
Mailing Address - Country:US
Mailing Address - Phone:503-851-8276
Mailing Address - Fax:
Practice Address - Street 1:1904 FUTURE DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2893
Practice Address - Country:US
Practice Address - Phone:503-851-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist