Healthcare Provider Details

I. General information

NPI: 1376083121
Provider Name (Legal Business Name): MS. CAROLINE JEAN CAULFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE JEAN WAMPFLER PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14232 SE MILL CT
PORTLAND OR
97233-2370
US

IV. Provider business mailing address

25117 SW PARKWAY AVE
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 503-960-2043
  • Fax: 503-261-8468
Mailing address:
  • Phone: 503-570-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number3930
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: