Provider Demographics
NPI:1750732772
Name:JILL L.NAVE, LMT
Entity type:Organization
Organization Name:JILL L.NAVE, LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NAVE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-515-1346
Mailing Address - Street 1:15653 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-5412
Mailing Address - Country:US
Mailing Address - Phone:503-515-1346
Mailing Address - Fax:
Practice Address - Street 1:12005 SW 70TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9634
Practice Address - Country:US
Practice Address - Phone:503-515-1346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty