Provider Demographics
NPI:1790015071
Name:DOUTHIT, REBECCA (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DOUTHIT
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 1:153 GRANITE ST APT B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2745
Mailing Address - Country:US
Mailing Address - Phone:547-579-0183
Mailing Address - Fax:
Practice Address - Street 1:108 E HERSEY ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1363
Practice Address - Country:US
Practice Address - Phone:541-579-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14436225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist