Healthcare Provider Details

I. General information

NPI: 1619846243
Provider Name (Legal Business Name): YING YAO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RICHARD FELIX REAUME

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MOUNTAIN VIEW LN STE 300
FOREST GROVE OR
97116-7244
US

IV. Provider business mailing address

1911 MOUNTAIN VIEW LN STE 300
FOREST GROVE OR
97116-7244
US

V. Phone/Fax

Practice location:
  • Phone: 503-381-5657
  • Fax: 503-381-5657
Mailing address:
  • Phone: 503-381-5657
  • Fax: 503-381-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26033
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: