Provider Demographics
NPI:1992113310
Name:ELKINS, VIKTORIJA (LMT#19596)
Entity type:Individual
Prefix:
First Name:VIKTORIJA
Middle Name:
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LMT#19596
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 BELMONT AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3793
Mailing Address - Country:US
Mailing Address - Phone:541-979-7152
Mailing Address - Fax:
Practice Address - Street 1:960 LIBERTY ST SE STE 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4149
Practice Address - Country:US
Practice Address - Phone:503-588-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist