Provider Demographics
NPI:1265079982
Name:SMARR, ROSALYN (LMT)
Entity type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:
Last Name:SMARR
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97825-0194
Mailing Address - Country:US
Mailing Address - Phone:541-620-4496
Mailing Address - Fax:
Practice Address - Street 1:135 FORD RD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-2010
Practice Address - Country:US
Practice Address - Phone:541-620-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7936OtherOREGON BOARD OF MASSAGE THERAPIST