Provider Demographics
NPI:1659702835
Name:TATTI, NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TATTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NICKI
Other - Middle Name:
Other - Last Name:TATTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:443 HRUBETZ RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4880
Mailing Address - Country:US
Mailing Address - Phone:541-401-1349
Mailing Address - Fax:
Practice Address - Street 1:189 LIBERTY ST SE
Practice Address - Street 2:B11
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:541-401-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19869225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist