Healthcare Provider Details

I. General information

NPI: 1356072987
Provider Name (Legal Business Name): ERICA ROBYN BURLEY MSTOM LAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 SE MORRISON ST STE 140
PORTLAND OR
97214-6309
US

IV. Provider business mailing address

819 SE MORRISON ST STE 140
PORTLAND OR
97214-6309
US

V. Phone/Fax

Practice location:
  • Phone: 503-862-8835
  • Fax: 888-972-4948
Mailing address:
  • Phone: 503-862-8835
  • Fax: 888-972-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICA ROBYN BURLEY
Title or Position: OWNER
Credential: DSOM, LAC
Phone: 503-862-8835