Individual
TAKAYO FACKRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1634 JEAN CT, EUGENE, OR 97402-3006
(541) 543-1548
Mailing address
1634 JEAN CT, EUGENE, OR 97402-3006
(541) 543-1548
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
12167
OR
Other
Enumeration date
05/08/2014
Last updated
05/13/2014
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