Provider Demographics
NPI:1104813393
Name:CAROL E SWEENEY
Entity type:Organization
Organization Name:CAROL E SWEENEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-752-0083
Mailing Address - Street 1:2865 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3516
Mailing Address - Country:US
Mailing Address - Phone:541-752-0083
Mailing Address - Fax:541-752-9624
Practice Address - Street 1:2865 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3516
Practice Address - Country:US
Practice Address - Phone:541-752-0083
Practice Address - Fax:541-752-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty