Healthcare Provider Details

I. General information

NPI: 1033664529
Provider Name (Legal Business Name): JOANNA HUTCHINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12353 SW WALNUT ST
TIGARD OR
97223-3039
US

IV. Provider business mailing address

12353 SW WALNUT ST
TIGARD OR
97223-3039
US

V. Phone/Fax

Practice location:
  • Phone: 808-499-5058
  • Fax:
Mailing address:
  • Phone: 808-499-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22408
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: