Provider Demographics
NPI:1245703172
Name:BEDOIAN, LEAH (LMT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BEDOIAN
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 1:2020 NE LINNEA DR APT 258
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4979
Mailing Address - Country:US
Mailing Address - Phone:518-335-6969
Mailing Address - Fax:
Practice Address - Street 1:371 SW UPPER TERRACE DR STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1560
Practice Address - Country:US
Practice Address - Phone:541-678-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0021593225700000X
ORLMT-26219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist