Healthcare Provider Details

I. General information

NPI: 1821262262
Provider Name (Legal Business Name): MELISSA DAWN STEWART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 SW BEAVERTON HILLSDALE HWY SUITE 3
PORTLAND OR
97225-2433
US

IV. Provider business mailing address

10865 SW 82ND AVE
TIGARD OR
97223-8405
US

V. Phone/Fax

Practice location:
  • Phone: 503-805-0508
  • Fax:
Mailing address:
  • Phone: 503-805-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12307
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: