Provider Demographics
NPI:1043837818
Name:FOXHOVEN, GWYNETH LOVE
Entity type:Individual
Prefix:
First Name:GWYNETH
Middle Name:LOVE
Last Name:FOXHOVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63530 JOHNSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9329
Mailing Address - Country:US
Mailing Address - Phone:541-749-0939
Mailing Address - Fax:541-385-0318
Practice Address - Street 1:335 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5162
Practice Address - Country:US
Practice Address - Phone:541-668-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist