Provider Demographics
NPI:1104319425
Name:LARSON-STEMKE, ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LARSON-STEMKE
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 1:3063 GROUSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7523
Mailing Address - Country:US
Mailing Address - Phone:541-510-8799
Mailing Address - Fax:541-747-1124
Practice Address - Street 1:2255 PIERCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1624
Practice Address - Country:US
Practice Address - Phone:541-510-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty