Provider Demographics
NPI:1427344696
Name:CONSER LAPHAM, JAYA (LMT)
Entity type:Individual
Prefix:MS
First Name:JAYA
Middle Name:
Last Name:CONSER LAPHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JAYA
Other - Middle Name:
Other - Last Name:LAPHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:107 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4715
Mailing Address - Country:US
Mailing Address - Phone:541-363-3100
Mailing Address - Fax:
Practice Address - Street 1:107 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4715
Practice Address - Country:US
Practice Address - Phone:541-363-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X, 376K00000X
OR5084225700000X
OR376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171R00000XOther Service ProvidersInterpreter
No376K00000XNursing Service Related ProvidersNurse's Aide