Healthcare Provider Details

I. General information

NPI: 1477719334
Provider Name (Legal Business Name): MARIE J MEIFFREN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 MARINE DR
ASTORIA OR
97103-2831
US

IV. Provider business mailing address

2935 MARINE DR
ASTORIA OR
97103-2831
US

V. Phone/Fax

Practice location:
  • Phone: 503-338-8106
  • Fax:
Mailing address:
  • Phone: 503-338-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14319
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: