Provider Demographics
NPI:1942488135
Name:RUCH, SHELLEY ANNE (LMT CCN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANNE
Last Name:RUCH
Suffix:
Gender:F
Credentials:LMT CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1795
Mailing Address - Country:US
Mailing Address - Phone:541-228-0634
Mailing Address - Fax:
Practice Address - Street 1:1835 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1795
Practice Address - Country:US
Practice Address - Phone:541-228-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
OR8159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist