Provider Demographics
NPI:1649435009
Name:MOSKALIK, NIKKIE RENEE (LMT)
Entity type:Individual
Prefix:
First Name:NIKKIE
Middle Name:RENEE
Last Name:MOSKALIK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NIKKIE
Other - Middle Name:RENEE
Other - Last Name:LATTION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3555 GLEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4734
Mailing Address - Country:US
Mailing Address - Phone:541-579-5587
Mailing Address - Fax:
Practice Address - Street 1:3555 GLEN OAK DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4734
Practice Address - Country:US
Practice Address - Phone:541-579-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14233225700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist