Healthcare Provider Details

I. General information

NPI: 1306438494
Provider Name (Legal Business Name): SAVHANNAH E BOURISAW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 SW HAMPTON ST STE 140
TIGARD OR
97223-8375
US

IV. Provider business mailing address

8700 SW ASH MEADOWS RD APT 1031
WILSONVILLE OR
97070-4058
US

V. Phone/Fax

Practice location:
  • Phone: 775-420-1027
  • Fax:
Mailing address:
  • Phone: 775-420-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number107699
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22644
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: