Healthcare Provider Details

I. General information

NPI: 1841242468
Provider Name (Legal Business Name): ANDREA FAITH THOMPSON L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12153 SE OATFIELD RD
MILWAUKIE OR
97222-6950
US

IV. Provider business mailing address

PO BOX 22559
MILWAUKIE OR
97269-2559
US

V. Phone/Fax

Practice location:
  • Phone: 503-387-3348
  • Fax: 503-387-3347
Mailing address:
  • Phone: 503-387-3348
  • Fax: 503-387-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6851
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: