Provider Demographics
NPI:1952540288
Name:SAGE, ZEORA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ZEORA
Middle Name:
Last Name:SAGE
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 1:6251 HWY 101 NORTH
Mailing Address - Street 2:
Mailing Address - City:YACHATS
Mailing Address - State:OR
Mailing Address - Zip Code:97498-9409
Mailing Address - Country:US
Mailing Address - Phone:541-547-4721
Mailing Address - Fax:
Practice Address - Street 1:6251 HWY 101 NORTH
Practice Address - Street 2:
Practice Address - City:YACHATS
Practice Address - State:OR
Practice Address - Zip Code:97498-9409
Practice Address - Country:US
Practice Address - Phone:541-547-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14786173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist