Healthcare Provider Details

I. General information

NPI: 1568720829
Provider Name (Legal Business Name): ALLISON DENISE KIRLEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 SW MACADAM AVE SUITE 200
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

8833 N SYRACUSE ST APT 5
PORTLAND OR
97203-4857
US

V. Phone/Fax

Practice location:
  • Phone: 503-841-6222
  • Fax:
Mailing address:
  • Phone: 503-703-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18656
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: