Provider Demographics
NPI:1659889285
Name:TAYLEENA M GLOSS
Entity type:Organization
Organization Name:TAYLEENA M GLOSS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYLEENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-241-5921
Mailing Address - Street 1:330 SE BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6038
Mailing Address - Country:US
Mailing Address - Phone:971-241-5921
Mailing Address - Fax:
Practice Address - Street 1:119 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4901
Practice Address - Country:US
Practice Address - Phone:971-241-5921
Practice Address - Fax:866-454-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty