Provider Demographics
NPI:1295907103
Name:MCKELVEY, LUCIA BLAINE (LMT)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:BLAINE
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:BLAINE
Other - Last Name:MCKELVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2906 INGALLS WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2379
Mailing Address - Country:US
Mailing Address - Phone:541-683-3286
Mailing Address - Fax:541-683-3286
Practice Address - Street 1:2906 INGALLS WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2379
Practice Address - Country:US
Practice Address - Phone:541-683-3286
Practice Address - Fax:541-683-3286
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist