Provider Demographics
NPI:1821225103
Name:WELLBODY THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:WELLBODY THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:541-390-4361
Mailing Address - Street 1:2195 NE PROFESSIONAL CT
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6028
Mailing Address - Country:US
Mailing Address - Phone:541-390-4361
Mailing Address - Fax:541-322-9398
Practice Address - Street 1:2195 NE PROFESSIONAL CT
Practice Address - Street 2:SUITE # 6
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6028
Practice Address - Country:US
Practice Address - Phone:541-390-4361
Practice Address - Fax:541-322-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR979838261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty