Provider Demographics
NPI:1457790321
Name:BARTELING, MAUREEN DIANE (LMT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:DIANE
Last Name:BARTELING
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 1:131 NW HAWTHORNE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2929
Mailing Address - Country:US
Mailing Address - Phone:541-420-3015
Mailing Address - Fax:
Practice Address - Street 1:131 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2929
Practice Address - Country:US
Practice Address - Phone:541-420-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15374174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15374OtherOREGON BOARD MASSAGE THERAPISTS