Provider Demographics
NPI:1194547570
Name:DOBBINS, TRACEY LEE (LMT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:DOBBINS
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 1:1041 S 10TH ST APT D8
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2657
Mailing Address - Country:US
Mailing Address - Phone:307-349-5598
Mailing Address - Fax:
Practice Address - Street 1:1663 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4113
Practice Address - Country:US
Practice Address - Phone:541-513-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist