Individual
BEEARA EDMONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2017 SE STONE ST, CORVALLIS, OR 97333-1830
(541) 752-1997
Mailing address
2017 SE STONE ST, CORVALLIS, OR 97333-1830
(541) 752-1997
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11734
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
TIN 93-0932697
OR
Enumeration date
06/01/2009
Last updated
04/12/2010
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