Healthcare Provider Details

I. General information

NPI: 1366803280
Provider Name (Legal Business Name): JAMIE OLLER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2016
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE BROADWAY ST
PORTLAND OR
97232-1569
US

IV. Provider business mailing address

5331 NE HOLMAN ST
PORTLAND OR
97218-2333
US

V. Phone/Fax

Practice location:
  • Phone: 785-331-9897
  • Fax:
Mailing address:
  • Phone: 785-331-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19383
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberLD-10196727
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: