Provider Demographics
NPI:1770364614
Name:CAMP, BRIANNA ODESSA (LMT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ODESSA
Last Name:CAMP
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 1:2001 GARDEN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2082
Mailing Address - Country:US
Mailing Address - Phone:541-513-9879
Mailing Address - Fax:
Practice Address - Street 1:1245 CHARNELTON ST STE 7
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6206
Practice Address - Country:US
Practice Address - Phone:541-513-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist