Provider Demographics
NPI:1356886808
Name:MARY WHEELER, LMT
Entity type:Organization
Organization Name:MARY WHEELER, LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-342-7339
Mailing Address - Street 1:67 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4108
Mailing Address - Country:US
Mailing Address - Phone:541-342-7339
Mailing Address - Fax:
Practice Address - Street 1:67 N POLK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4108
Practice Address - Country:US
Practice Address - Phone:541-342-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4677172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4677OtherSTATE OF OREGON BOARD OF MASSAGE THERAPISTS