Healthcare Provider Details

I. General information

NPI: 1295056208
Provider Name (Legal Business Name): PAIGE PAHL L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 MARINE DR
ASTORIA OR
97103-2831
US

IV. Provider business mailing address

PO BOX 324
ASTORIA OR
97103-0324
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-1735
  • Fax:
Mailing address:
  • Phone: 503-325-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7185
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: