Provider Demographics
NPI:1174348015
Name:HERRING, GRACE CAROLE (LMT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CAROLE
Last Name:HERRING
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 1:1404 CAMP BAKER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-9604
Mailing Address - Country:US
Mailing Address - Phone:575-644-1812
Mailing Address - Fax:
Practice Address - Street 1:1404 CAMP BAKER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-9604
Practice Address - Country:US
Practice Address - Phone:575-644-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist