Healthcare Provider Details

I. General information

NPI: 1114138898
Provider Name (Legal Business Name): EMILY CAITLIN CROWE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 NE MAIN ST
ESTACADA OR
97023-8528
US

IV. Provider business mailing address

38223 SE COUPLAND RD
ESTACADA OR
97023-7516
US

V. Phone/Fax

Practice location:
  • Phone: 503-630-4037
  • Fax: 503-630-5636
Mailing address:
  • Phone: 503-630-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11128
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: