Provider Demographics
NPI:1295118974
Name:ALISON SANDERS LMT
Entity type:Organization
Organization Name:ALISON SANDERS LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:NISSA
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-591-1618
Mailing Address - Street 1:1803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2636
Mailing Address - Country:US
Mailing Address - Phone:541-591-1618
Mailing Address - Fax:
Practice Address - Street 1:1803 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2636
Practice Address - Country:US
Practice Address - Phone:541-591-1618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR163000OtherSTATE LICENSE