Provider Demographics
NPI:1245623065
Name:MOMSEN, MARA
Entity type:Individual
Prefix:MS
First Name:MARA
Middle Name:
Last Name:MOMSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ASHLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3167
Mailing Address - Country:US
Mailing Address - Phone:541-663-6896
Mailing Address - Fax:
Practice Address - Street 1:500 ASHLAND LOOP
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3167
Practice Address - Country:US
Practice Address - Phone:541-663-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist