Provider Demographics
NPI:1154938249
Name:RAMON, GRETCHEN MAY (LMT)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:MAY
Last Name:RAMON
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 1:61235 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2735
Mailing Address - Country:US
Mailing Address - Phone:918-510-8536
Mailing Address - Fax:
Practice Address - Street 1:61235 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2735
Practice Address - Country:US
Practice Address - Phone:918-510-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty