Provider Demographics
NPI:1831887009
Name:LOKAN, MYA MICHELLE (LMT)
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:MICHELLE
Last Name:LOKAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:MICHELLE
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:46164 GOODPASTURE RD.
Mailing Address - Street 2:
Mailing Address - City:VIDA
Mailing Address - State:OR
Mailing Address - Zip Code:97488
Mailing Address - Country:US
Mailing Address - Phone:541-790-9859
Mailing Address - Fax:
Practice Address - Street 1:112 49TH ST.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478
Practice Address - Country:US
Practice Address - Phone:541-726-6521
Practice Address - Fax:541-726-1615
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist