Provider Demographics
NPI:1790023711
Name:MCCAUL, JUDITH ANN (LMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:MCCAUL
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 1:384 SW UPPER TERRACE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3432
Mailing Address - Country:US
Mailing Address - Phone:541-350-4116
Mailing Address - Fax:
Practice Address - Street 1:2330 NE DIVISION ST STE 8
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3570
Practice Address - Country:US
Practice Address - Phone:541-350-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR19181OtherOBMT