Healthcare Provider Details

I. General information

NPI: 1023341310
Provider Name (Legal Business Name): ALYSSA MARIE SPECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10395 NW GLENCOE RD SUITE 400
NORTH PLAINS OR
97133-8208
US

IV. Provider business mailing address

7286 NE SHALEEN ST
HILLSBORO OR
97124-9410
US

V. Phone/Fax

Practice location:
  • Phone: 503-647-0719
  • Fax:
Mailing address:
  • Phone: 503-735-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12163
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: