Individual
MS. SUSANNAH JANE ELDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T., NCBTMB
Contact information
Practice address
832 E MAIN ST, STE. 6, MEDFORD, OR 97504-7153
(541) 772-5939
(541) 770-5939
Mailing address
832 E MAIN ST, STE. 6, MEDFORD, OR 97504-7153
(541) 772-5939
(541) 770-5939
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10482
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10482
BOARD OF MASSAGE LICENSE
OR
Enumeration date
11/14/2006
Last updated
07/08/2007
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