Provider Demographics
NPI:1255141404
Name:STAIRS, ATHENA (LMT)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:STAIRS
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 1:2397 NW KINGS BLVD # 126
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3986
Mailing Address - Country:US
Mailing Address - Phone:541-671-8012
Mailing Address - Fax:
Practice Address - Street 1:260 SW MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4798
Practice Address - Country:US
Practice Address - Phone:541-671-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist