Provider Demographics
NPI:1285985945
Name:DAVIS, NATALIE (LMT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DAVIS
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 1:215 N BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2734
Mailing Address - Country:US
Mailing Address - Phone:971-264-0669
Mailing Address - Fax:855-915-0272
Practice Address - Street 1:215 N BLAINE ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2734
Practice Address - Country:US
Practice Address - Phone:971-264-0669
Practice Address - Fax:855-915-0272
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist