Provider Demographics
NPI:1922354802
Name:POWERS, JUDY MARIE VEARY (LMT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MARIE VEARY
Last Name:POWERS
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 1:3730 NW JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4946
Mailing Address - Country:US
Mailing Address - Phone:541-610-4175
Mailing Address - Fax:
Practice Address - Street 1:3730 NW JACKSON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4946
Practice Address - Country:US
Practice Address - Phone:541-610-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty