Provider Demographics
NPI:1841421484
Name:PAYNE, REBECCA MARY (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARY
Last Name:PAYNE
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 1:2266 MCGILCHRIST ST SE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1019
Mailing Address - Country:US
Mailing Address - Phone:503-302-3388
Mailing Address - Fax:
Practice Address - Street 1:2266 MCGILCHRIST ST SE
Practice Address - Street 2:SUITE #100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1019
Practice Address - Country:US
Practice Address - Phone:503-302-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist