Provider Demographics
NPI:1063164705
Name:WARINNER, MOLLY F (LMT)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:F
Last Name:WARINNER
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 1:61529 TWIN LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9586
Mailing Address - Country:US
Mailing Address - Phone:509-540-5081
Mailing Address - Fax:
Practice Address - Street 1:2445 NE DIVISION ST STE 204
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3568
Practice Address - Country:US
Practice Address - Phone:541-229-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist