Provider Demographics
NPI:1952768996
Name:PIATT, MONIKA EDITH (LMT)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:EDITH
Last Name:PIATT
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 1:23095 ALFALFA MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9393
Mailing Address - Country:US
Mailing Address - Phone:541-815-1061
Mailing Address - Fax:541-549-2155
Practice Address - Street 1:325 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-5047
Practice Address - Country:US
Practice Address - Phone:541-549-3534
Practice Address - Fax:541-549-1272
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18380OtherMASSAGE THERAPY LICENSE