Healthcare Provider Details

I. General information

NPI: 1215207121
Provider Name (Legal Business Name): COLLEEN MARIE WHELAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 JOHN ADAMS ST
OREGON CITY OR
97045-1955
US

IV. Provider business mailing address

710 JOHN ADAMS ST
OREGON CITY OR
97045-1955
US

V. Phone/Fax

Practice location:
  • Phone: 503-722-7776
  • Fax: 503-723-0789
Mailing address:
  • Phone: 503-722-7776
  • Fax: 503-723-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15230
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: