Provider Demographics
NPI:1285104646
Name:DOOMS, TABITHA JO (LMT)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:JO
Last Name:DOOMS
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 1:1026 NE RAMBLING LN APT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6683
Mailing Address - Country:US
Mailing Address - Phone:541-848-9938
Mailing Address - Fax:
Practice Address - Street 1:1288 SW SIMPSON AVE STE F
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3196
Practice Address - Country:US
Practice Address - Phone:541-312-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty