Provider Demographics
NPI:1598014672
Name:RITTEN, MYRNA LEE (BA, LMT)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:LEE
Last Name:RITTEN
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5718
Mailing Address - Country:US
Mailing Address - Phone:541-554-7813
Mailing Address - Fax:541-603-1887
Practice Address - Street 1:4770 VILLAGE PLAZA LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6675
Practice Address - Country:US
Practice Address - Phone:541-554-7813
Practice Address - Fax:541-603-1887
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist