Healthcare Provider Details

I. General information

NPI: 1972418994
Provider Name (Legal Business Name): TABITHA PATTERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E POWELL BLVD
GRESHAM OR
97030-7605
US

IV. Provider business mailing address

35811 E HISTORIC COLUMBIA RIVER HWY APT 3
CORBETT OR
97019-8838
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-1500
  • Fax:
Mailing address:
  • Phone: 503-349-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19959
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: