Provider Demographics
NPI:1447968938
Name:WHITTINGTON, MICAELA (LMT)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:WHITTINGTON
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 1:1604 LUND RD
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9107
Mailing Address - Country:US
Mailing Address - Phone:541-536-4902
Mailing Address - Fax:
Practice Address - Street 1:1134 SE CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1366
Practice Address - Country:US
Practice Address - Phone:408-710-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist