Provider Demographics
NPI:1053783241
Name:CRANIOSACRAL THERAPY
Entity type:Organization
Organization Name:CRANIOSACRAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIOSACRAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HARMONY
Authorized Official - Middle Name:EDEN
Authorized Official - Last Name:OLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-291-1801
Mailing Address - Street 1:145 S HOLLY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3101
Mailing Address - Country:US
Mailing Address - Phone:541-291-1801
Mailing Address - Fax:
Practice Address - Street 1:145 S HOLLY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3101
Practice Address - Country:US
Practice Address - Phone:541-291-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR441893-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty