Provider Demographics
NPI:1689386039
Name:CLAYTON, LORI LYN (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYN
Last Name:CLAYTON
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 1:485 S 49TH PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6722
Mailing Address - Country:US
Mailing Address - Phone:801-834-4146
Mailing Address - Fax:
Practice Address - Street 1:311 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3402
Practice Address - Country:US
Practice Address - Phone:541-636-3079
Practice Address - Fax:866-898-9393
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist