Healthcare Provider Details

I. General information

NPI: 1508847468
Provider Name (Legal Business Name): TAYA S. LINDLEY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 SE 80TH AVE
PORTLAND OR
97215-1528
US

IV. Provider business mailing address

404 SE 80TH AVE
PORTLAND OR
97215-1528
US

V. Phone/Fax

Practice location:
  • Phone: 503-335-3201
  • Fax:
Mailing address:
  • Phone: 503-349-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00655
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: