Healthcare Provider Details

I. General information

NPI: 1124653969
Provider Name (Legal Business Name): CLAIRE ZAVISLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N MISSISSIPPI AVE
PORTLAND OR
97227-1158
US

IV. Provider business mailing address

3737 N MISSISSIPPI AVE
PORTLAND OR
97227-1158
US

V. Phone/Fax

Practice location:
  • Phone: 503-467-4511
  • Fax:
Mailing address:
  • Phone: 503-467-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24903
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: