Provider Demographics
NPI:1659644177
Name:COCOON MASSAGE LLC
Entity Type:Organization
Organization Name:COCOON MASSAGE LLC
Other - Org Name:COCOON MASSAGE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-266-4162
Mailing Address - Street 1:818 SW 3RD AVE
Mailing Address - Street 2:PMB 263
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204
Mailing Address - Country:US
Mailing Address - Phone:503-490-1901
Mailing Address - Fax:
Practice Address - Street 1:7831 SE STARK ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2357
Practice Address - Country:US
Practice Address - Phone:971-266-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10253225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty