Provider Demographics
NPI:1639548027
Name:OPEIFA, OMOLARA LYNETTE (LMT)
Entity Type:Individual
Prefix:
First Name:OMOLARA
Middle Name:LYNETTE
Last Name:OPEIFA
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 1:2920 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3716
Mailing Address - Country:US
Mailing Address - Phone:541-207-5966
Mailing Address - Fax:
Practice Address - Street 1:190 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4160
Practice Address - Country:US
Practice Address - Phone:541-484-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist