Provider Demographics
NPI:1295098937
Name:GEBER, JEZELLE MARGO
Entity type:Individual
Prefix:
First Name:JEZELLE
Middle Name:MARGO
Last Name:GEBER
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 1:950 SE 32ND ST
Mailing Address - Street 2:APT 14
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-1803
Mailing Address - Country:US
Mailing Address - Phone:503-888-2234
Mailing Address - Fax:
Practice Address - Street 1:2728 NE HIGHWAY 101
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4412
Practice Address - Country:US
Practice Address - Phone:541-994-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist