Healthcare Provider Details

I. General information

NPI: 1811714744
Provider Name (Legal Business Name): THE EMBODIED WELLNESS STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 SOUTHWEST BEVELAND STREET SUITE 105
TIGARD OR
97223
US

IV. Provider business mailing address

7175 SOUTHWEST BEVELAND STREET SUITE 105
TIGARD OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-308-9593
  • Fax:
Mailing address:
  • Phone: 503-308-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: KATERINA BARATTA
Title or Position: ACUPUNCTURIST, OWNER
Credential: LAC
Phone: 503-308-9593