Provider Demographics
NPI:1730657768
Name:MYRES, JOSIE RENEE
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:RENEE
Last Name:MYRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2901
Mailing Address - Country:US
Mailing Address - Phone:541-686-4461
Mailing Address - Fax:541-686-4465
Practice Address - Street 1:35 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2901
Practice Address - Country:US
Practice Address - Phone:541-686-4461
Practice Address - Fax:541-686-4465
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist